{ "hospital_name": "Ressurection Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Ressurection Medical Center" ], "hospital_address": [ "7435 West Talcott Ave., Chicago, Illinois 60631" ], "license_information": { "license_number": "992392397", "state": "IL" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Luis Leon" }, "type_2_npi": [ "1811735228", "1700695566" ], "standard_charge_information": [ { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3113.86, "maximum": 3269.55, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.55, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5308.12, "maximum": 5573.53, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9945.67, "minimum": 445.72, "maximum": 9945.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 445.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 445.72 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9945.67 } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8971.17, "maximum": 9419.73, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9419.73, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9357.0, "minimum": 5672.3208, "maximum": 15158.7936, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11228.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8714.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10627.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 10427.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10476.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7884.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11706.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 14440.69 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11696.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13100.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 15158.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11531.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8628.46 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8382.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14503.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11213.3 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7639.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9129.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8714.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8714.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14035.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8548.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8714.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9357.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9357.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9702.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8299.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9357.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12057.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8548.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 1", "code_information": [ { "code": "5431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4266.58, "maximum": 4479.91, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 3", "code_information": [ { "code": "5433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7975.09, "maximum": 8373.84, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8373.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3860.1, "maximum": 4053.1, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4053.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5982.48, "maximum": 6281.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4021.41, "maximum": 4222.48, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4222.48, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Acellular derm matrix implt", "code_information": [ { "code": "15777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17837.84, "minimum": 212.39, "maximum": 14805.4072, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.39 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1682.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 } ] }, { "setting": "outpatient", "gross_charge": 17837.8, "minimum": 212.39, "maximum": 14805.4072, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.39 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1682.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5046.2, "maximum": 5298.51, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5298.51, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7923.0, "minimum": 5213.64, "maximum": 31334.4413, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9508.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7388.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8916.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8748.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8790.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6684.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9822.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12116.24 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9904.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11093.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12836.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9674.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7239.58 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7106.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12281.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8581.44 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6637.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7740.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7388.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11885.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7247.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7388.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7923.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7923.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5213.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7923.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9227.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7247.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 4", "code_information": [ { "code": "5434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23643.17, "maximum": 24825.33, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24825.33, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8708.0, "minimum": 5937.0642, "maximum": 27152.58, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10450.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8114.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9853.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9668.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9714.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7342.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10854.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13389.36 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10886.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12192.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14108.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10691.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8000.28 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13498.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25251.9 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6950.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8501.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8114.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8114.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13063.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7960.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8114.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8708.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8708.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12351.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7728.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8708.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27152.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7960.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5313.2, "maximum": 5578.86, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5578.86, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2724.84, "maximum": 2861.08, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2861.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7821.66, "maximum": 8212.74, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8212.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 4", "code_information": [ { "code": "5644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15266.36, "maximum": 16029.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16029.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5655.67, "maximum": 5938.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5938.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Acetylcholine Chloride Intraocular For Soln 20 Mg (1:100)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "24208053920", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9845.88, "maximum": 10338.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10338.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7433.36, "maximum": 7805.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7805.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5192.13, "maximum": 5451.74, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15300.75, "maximum": 16065.79, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16065.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3979.42, "maximum": 4178.39, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4178.39, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15612.0, "minimum": 8054.9208, "maximum": 36760.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18734.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14502.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 18090.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 17750.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17834.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 13121.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19928.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 24582.45 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19515.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21857.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 25291.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19629.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14688.27 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13950.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24198.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34187.27 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11194.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15193.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14502.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14502.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23418.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14226.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14502.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15612.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15612.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8753.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13812.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15612.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36760.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14226.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7248.77, "maximum": 7611.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7611.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8979.0, "minimum": 3393.6, "maximum": 14547.2598, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10775.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8365.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10176.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9985.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10032.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7568.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11210.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13828.62 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11224.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12571.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14547.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11042.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8262.74 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8046.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13918.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9620.54 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6806.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8763.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8365.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13469.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8206.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8979.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8979.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7466.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8979.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10344.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8206.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6266.8, "maximum": 6580.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6580.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24488.0, "minimum": 14788.5816, "maximum": 120417.4666, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24488.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 65871.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22283.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29385.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22716.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 28681.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 28142.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 28276.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 20552.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 31594.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 38974.18 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 30610.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34283.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 39670.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 31121.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 23287.47 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 37956.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61260.63 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 19393.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23797.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 33300.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 40500.0, "10th_percentile": 40500.0, "90th_percentile": 40500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 21634.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22716.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22716.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36732.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 22283.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22716.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24488.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24488.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33984.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10518.54, "maximum": 11044.47, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11044.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2916.8, "maximum": 3062.64, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3062.64, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11724.59, "maximum": 12310.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12310.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3814.79, "maximum": 4005.53, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8614.0, "minimum": 5869.3726, "maximum": 41420.66, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10337.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8027.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9741.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9557.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9603.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7263.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10730.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13236.7 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10768.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12060.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13955.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10569.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7909.07 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7721.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13352.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38521.21 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6544.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8410.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8027.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8027.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12922.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7874.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8027.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8614.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8614.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11673.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8614.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41420.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7874.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3954.48, "maximum": 4152.2, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.2, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10951.32, "maximum": 11498.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11498.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 4", "code_information": [ { "code": "7564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8171.71, "maximum": 8580.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8580.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 3", "code_information": [ { "code": "7553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4505.33, "maximum": 4730.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4730.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11282.0, "minimum": 6804.0, "maximum": 61317.2809, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13539.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10496.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12924.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12681.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12742.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9497.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 14237.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 17563.01 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14103.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15796.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 18278.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14024.25 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10494.08 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10096.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17488.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28317.78 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9021.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10996.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10496.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10496.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16924.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10296.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10496.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11282.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11282.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9996.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11282.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30449.23 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10296.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20399.33, "maximum": 21419.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 21419.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3113.45, "maximum": 3269.12, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.12, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12879.0, "minimum": 4252.5, "maximum": 44509.6862, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15455.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11974.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 14830.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14551.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14620.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10834.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 16336.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 20152.45 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16099.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18031.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20865.58, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16091.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12041.3 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11518.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19963.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32453.36 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10174.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12544.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11974.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19319.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11746.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12879.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18739.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12879.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34896.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11746.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7430.0, "minimum": 3518.96, "maximum": 12150.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8916.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6932.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8328.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8171.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8210.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6271.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9174.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11316.94 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9288.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10403.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12037.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9036.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6761.99 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11517.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8146.93 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4815.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7262.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6932.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6932.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11146.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6800.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6932.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7430.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7430.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3518.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7430.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8760.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6800.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18977.0, "minimum": 10565.748, "maximum": 121788.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22773.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17616.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 22106.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 21690.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21793.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15939.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24351.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 30039.3 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23722.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26568.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 30743.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23986.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17948.79 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16945.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29415.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113263.63 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 15164.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18455.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17616.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17616.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28466.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17281.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17616.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18977.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18977.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22936.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16778.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18977.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 121788.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17281.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5134.34, "maximum": 5391.06, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5391.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8705.1, "maximum": 9140.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9140.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5660.25, "maximum": 5943.26, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5943.26, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49213.0, "minimum": 18071.3712, "maximum": 175697.39, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59056.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45595.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 58184.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 57090.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 57362.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 41252.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 64094.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 79064.5 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 61517.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68899.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79726.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 63133.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 47241.85 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43858.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 76281.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 163398.57 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 39243.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47766.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45595.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45595.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73820.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 44726.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45595.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 49213.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49213.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103507.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49213.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 175697.39 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44726.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3095.99, "maximum": 3250.79, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3250.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15339.83, "maximum": 16106.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16106.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6873.0, "minimum": 4617.7166, "maximum": 35592.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8248.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6416.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7663.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7519.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7555.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5805.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8442.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10413.95 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8592.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9623.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11135.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8315.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6222.44 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6172.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10654.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33101.33 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5148.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6722.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6416.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10310.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6294.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6873.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6873.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10470.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6873.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35592.83 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6294.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10783.0, "minimum": 5487.57, "maximum": 18450.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12940.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10034.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12329.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12097.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12155.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9079.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13581.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16753.63 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13479.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15097.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17469.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13377.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10010.46 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9652.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16714.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14037.61 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8258.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10512.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10034.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10034.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16175.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9843.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10034.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10783.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10783.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5487.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10783.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15094.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9843.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4015.18, "maximum": 4215.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11018.0, "minimum": 5438.3928, "maximum": 69597.64, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13221.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10251.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12609.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12371.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12430.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9275.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13889.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 17133.83 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13772.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15425.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17849.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13681.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10237.64 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9861.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17078.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64725.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7660.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10739.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10251.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10251.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16527.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10056.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10251.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11018.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11018.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28038.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11018.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69597.64 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10056.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6599.0, "minimum": 4420.3892, "maximum": 31702.71, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7919.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6162.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7336.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7198.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7232.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5575.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8081.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9968.93 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8249.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9239.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10690.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7960.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5956.54 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10228.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29483.52 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5261.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6456.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6162.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9899.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6045.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6599.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6599.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9348.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6599.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31702.71 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1960.2, "maximum": 2058.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2058.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35517.57, "maximum": 37293.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 37293.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17015.0, "minimum": 9756.5304, "maximum": 62790.63, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20418.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15801.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 19765.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 19393.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19485.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 14296.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 21772.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 26857.94 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21269.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23821.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 27565.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21446.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16047.89 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15199.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 26374.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 58395.29 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13179.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16553.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15801.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15801.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25523.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15500.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15801.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17015.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17015.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23419.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17015.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62790.63 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15500.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7766.36, "maximum": 8154.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8154.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14699.0, "minimum": 7963.0824, "maximum": 55980.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17638.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13657.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17001.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 16681.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16760.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12357.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 18727.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 23101.94 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18373.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20578.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23812.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18447.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13803.65 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13137.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22783.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52061.55 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11653.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14308.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13657.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13657.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22048.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13397.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13657.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14699.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17315.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14699.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55980.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13397.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18045.0, "minimum": 5997.2208, "maximum": 43637.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21654.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16753.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 20993.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 20598.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20696.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15158.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 23125.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 28527.11 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22556.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25263.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 29232.95, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22779.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17045.24 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16115.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27969.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40582.8 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13883.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17551.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16753.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16753.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27067.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16434.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16753.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18045.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18045.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32140.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18045.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43637.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16434.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 2", "code_information": [ { "code": "7552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2873.98, "maximum": 3017.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3017.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10453.0, "minimum": 6964.9896, "maximum": 19579.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9729.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11935.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11710.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11766.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13147.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16217.88 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13066.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14634.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16934.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12950.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9690.35 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9358.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16202.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18208.52 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8084.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10192.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9729.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9729.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15680.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9543.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9729.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10453.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10453.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17727.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9265.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10453.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19579.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9543.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12544.02, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5770.0, "minimum": 3824.5754, "maximum": 28241.9664, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 6924.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5395.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 6347.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6228.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6257.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 4882.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 6992.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 8625.24 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7213.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8078.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9348.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 6887.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5153.67 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5190.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 8944.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14616.37 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 3985.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5652.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5395.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5395.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8655.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5293.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5395.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5770.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5770.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7083.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5770.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15716.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5293.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3063.97, "maximum": 3217.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3217.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7591.0, "minimum": 5133.7054, "maximum": 18184.7224, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9109.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7080.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8520.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8359.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8399.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6406.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9385.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11577.62 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9489.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10628.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12298.21, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9244.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6917.74 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11766.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10698.94 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5804.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7418.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7080.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11387.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6946.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7591.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7591.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11355.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6743.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7591.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11504.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6946.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19919.0, "minimum": 7654.5, "maximum": 51995.96, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23903.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18488.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 23229.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 22792.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22901.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 16727.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 25589.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 31565.89 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24898.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27886.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 32269.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25205.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 18860.94 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17783.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30874.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48356.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 16180.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19368.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18488.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18488.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29878.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18135.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18488.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19919.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19919.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30901.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19919.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51995.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18135.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12993.83, "maximum": 13643.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13643.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32321.4, "maximum": 33937.47, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33937.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40975.0, "minimum": 18909.18, "maximum": 66380.31, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 49170.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37972.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 48354.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 47445.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 47671.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 34355.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 53266.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 65706.82 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 51219.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 57365.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 66380.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 52467.6 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 39260.5 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36525.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 63512.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42582.22 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 34696.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39780.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37972.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37972.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 61463.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 37248.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37972.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 40975.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40975.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61653.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36164.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 40975.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45787.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37248.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19250.24, "maximum": 20212.75, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20212.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13024.0, "minimum": 8365.48, "maximum": 34200.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15629.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12108.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 15003.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14721.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14791.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10955.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 16527.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 20387.2 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16280.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18234.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 21100.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16279.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12181.56 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11647.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20188.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16668.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10280.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12685.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12108.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12108.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19537.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11877.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12108.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13024.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13024.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8365.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11531.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13024.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17923.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6026.0, "minimum": 4008.4922, "maximum": 22384.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7231.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5632.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 6652.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6527.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6558.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5096.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7328.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9040.02 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7533.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8437.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9762.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7218.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5401.5 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9340.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7930.28 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4161.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5900.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5632.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5632.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9039.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5525.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5632.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6026.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6026.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22384.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5364.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6026.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8527.18 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5525.39, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5865.62, "maximum": 6158.9, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6158.9, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2137.3, "maximum": 2244.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2244.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32588.0, "minimum": 18450.0, "maximum": 218372.0135, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39106.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30211.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 38347.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 37626.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 37805.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 27334.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 42242.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 52108.63 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 40736.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 45624.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 52793.95, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41609.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 31135.44 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 29060.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 50512.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81872.72 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 25327.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31650.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30211.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 30211.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48883.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 29636.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30211.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32588.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32588.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45005.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28773.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32588.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 88035.18 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29636.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5930.0, "minimum": 2430.0, "maximum": 9607.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7116.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5543.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 6538.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6415.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6445.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5015.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7202.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 8884.48 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7413.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8302.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9607.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7094.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5308.57 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5332.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9192.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7611.95 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4431.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5807.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5543.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5543.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8895.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5438.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5543.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5930.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5930.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4385.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5930.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8184.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5438.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 2", "code_information": [ { "code": "7722", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3767.82, "maximum": 3956.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3956.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3179.55, "maximum": 3338.53, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3338.53, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6737.83, "maximum": 7074.72, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7074.72, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 3", "code_information": [ { "code": "7723", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4613.42, "maximum": 4844.09, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4844.09, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15387.0, "minimum": 5772.8232, "maximum": 26557.65, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18464.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14294.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17822.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 17487.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17570.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12933.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19632.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 24218.08 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19234.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21542.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24927.69, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19338.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14470.55 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23850.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24698.61 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 12339.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14975.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14294.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23081.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14022.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15387.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15387.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13614.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15387.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26557.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14022.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 4", "code_information": [ { "code": "7724", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12180.65, "maximum": 12789.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12789.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15951.0, "minimum": 5832.0, "maximum": 26335.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19141.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14816.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 18495.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 18147.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 18234.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 13405.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 20374.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 25132.6 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19939.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22332.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 25841.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20068.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 15016.99 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24724.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24492.34 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 12643.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15522.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14816.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14816.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23927.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14534.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14816.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15951.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15951.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15951.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26335.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14534.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6369.0, "minimum": 4254.9918, "maximum": 20017.4892, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7643.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5949.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7061.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6928.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6961.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5383.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7779.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9595.93 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7961.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8917.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10318.25, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7662.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5733.66 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5723.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9872.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7721.98 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4715.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6233.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5949.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5949.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9553.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5836.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5949.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6369.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6369.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5020.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5666.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6369.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8303.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.61, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2516.45, "maximum": 2642.27, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2642.27, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 97904.61, "maximum": 102799.84, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 102799.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8292.0, "minimum": 4009.5, "maximum": 14850.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9950.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7729.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9356.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9180.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9224.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6993.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10306.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12713.92 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10365.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11609.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13433.53, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10152.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7596.7 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7434.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12853.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8925.4 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6263.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8097.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7729.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7729.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12438.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7582.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7729.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8292.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8292.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8292.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9597.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7582.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 3", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 125164.59, "maximum": 131422.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 131422.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3446.87, "maximum": 3619.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3619.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3428.99, "maximum": 3600.44, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3600.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 212385.74, "maximum": 223005.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 223005.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4424.68, "maximum": 4645.91, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3823.11, "maximum": 4014.27, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4014.27, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14171.19, "maximum": 14879.75, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14879.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 3", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5882.66, "maximum": 6176.79, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6176.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11947.84, "maximum": 12545.23, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12545.23, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Alys smpl sppn npgt wprgrm", "code_information": [ { "code": "95971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6474.24, "discounted_cash": 101.0, "minimum": 37.64, "maximum": 5373.6192, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 121.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 157.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 106.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 96.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 136.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 141.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 164.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 157.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 111.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 106.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 152.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 104.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.64 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 123.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.13, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 126.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6114.23, "maximum": 6419.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6419.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 87176.42, "maximum": 91535.24, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 91535.24, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 107197.0, "minimum": 76746.3094, "maximum": 173659.5612, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 128636.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 99249.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 127372.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 124975.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 125571.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 89797.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 140308.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 173079.51 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 133996.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 150076.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 173659.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 138205.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 103416.79 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 95468.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 166155.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 93022.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 103975.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 99249.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 99249.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 160795.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 97359.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 99249.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 107197.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 107197.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 133499.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 94523.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 107197.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 97359.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26286.99, "maximum": 27601.34, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27601.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4525.29, "maximum": 4751.55, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4751.55, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7343.14, "maximum": 7710.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11504.66, "maximum": 12079.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8183.0, "minimum": 4819.5, "maximum": 19457.1935, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9820.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7629.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9227.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9053.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9096.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6902.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10164.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12538.22 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10229.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11457.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13257.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10011.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7491.71 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7338.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12685.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12584.15 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6254.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7992.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7629.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7629.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12275.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7483.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7629.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8183.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8183.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8388.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8183.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13531.34 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7483.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12747.0, "minimum": 8840.7784, "maximum": 45880.93, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15297.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11852.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 14672.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14396.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14465.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10723.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 16162.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 19937.87 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15934.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17846.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20651.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15920.6 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11913.08 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11400.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19758.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42669.26 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10720.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12416.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11852.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11852.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19121.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11626.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11852.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12747.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12747.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19049.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11287.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12747.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45880.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11626.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3763.66, "maximum": 3951.84, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3951.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7011.39, "maximum": 7361.96, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7361.96, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20664.0, "minimum": 14532.6202, "maximum": 43591.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24797.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19177.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 24119.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 23665.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23778.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 17351.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 26568.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 32774.2 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 25830.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 28930.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 33476.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26170.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 19582.92 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18447.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 32029.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40540.06 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 15316.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20090.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19177.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19177.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30996.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18812.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19177.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20664.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20664.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20664.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43591.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18812.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11090.17, "maximum": 11644.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11644.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Amputation of midfoot", "code_information": [ { "code": "28800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3731.17, "discounted_cash": 3489.0, "minimum": 538.31, "maximum": 3731.17, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 3731.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 538.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 538.31 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3731.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3731.17, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10933.0, "minimum": 7087.5, "maximum": 18763.43, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13120.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10173.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12508.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12273.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12331.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9204.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13778.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16997.02 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13667.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15307.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17712.9, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13572.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10155.89 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9786.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16947.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17449.99 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8258.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10658.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10173.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10173.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16400.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9979.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10173.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10933.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10933.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9779.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9689.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10933.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18763.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9979.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23239.83, "maximum": 24401.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24401.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Amputation Toe & Metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104.0, "discounted_cash": 3489.0, "minimum": 440.58, "maximum": 10876.32, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5988.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF FINGERTHUMB", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14060.0, "discounted_cash": 3489.0, "minimum": 690.0, "maximum": 11669.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4736.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4898.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1958.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1958.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.44 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1864.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4736.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 14060.0, "discounted_cash": 3489.0, "minimum": 690.0, "maximum": 11669.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4736.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4898.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1958.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1958.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.44 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1864.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1865.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4736.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3056.34, "maximum": 3209.16, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3209.16, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10772.97, "maximum": 11311.62, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.62, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14160.38, "maximum": 14868.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14868.4, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25769.0, "minimum": 11994.4416, "maximum": 66047.02, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 30923.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23901.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 30211.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 29642.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 29784.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 21625.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 33279.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 41052.36 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 32212.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 36077.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 41747.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32780.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 24529.21 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 39943.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61423.73 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 20676.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 25040.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23901.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 23901.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 38654.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 23446.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23901.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25769.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25769.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23687.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22763.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 25769.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 66047.02 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23446.71, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3149.62, "maximum": 3307.1, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3307.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31427.0, "minimum": 16204.2792, "maximum": 91298.73, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 37712.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29136.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 36961.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 36265.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36438.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 26361.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 40715.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 50224.87 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 39283.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 43997.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 50911.84, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 40105.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 30009.88 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28026.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 48711.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 84907.82 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 27441.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 30524.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29136.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29136.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 47140.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 28581.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29136.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31427.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31427.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27907.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27749.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 31427.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91298.73 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28581.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44166.0, "minimum": 24696.732, "maximum": 126455.0897, "payers_information": [ { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 35761.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 42874.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40925.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 40925.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 66250.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 40145.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40925.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 44166.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44166.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44980.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 44166.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 119021.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 40145.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 53000.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40925.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 52162.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 51181.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 51425.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 37027.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 57460.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 70881.39 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 55208.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 61833.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 71550.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 56599.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 42352.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 39366.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 68458.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 110690.32 } ] } ] }, { "description": "Anoscopy And Biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 1276.0, "minimum": 80.2, "maximum": 7544.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1531.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1212.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1722.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1786.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2067.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1427.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1467.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1397.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1403.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1914.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.2 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 854.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2821.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1595.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1427.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11096.2, "discounted_cash": 3489.0, "minimum": 720.6, "maximum": 9209.8792, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 720.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 720.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 11096.24, "discounted_cash": 3489.0, "minimum": 720.6, "maximum": 9209.8792, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 720.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 720.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8835.64, "maximum": 9277.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9277.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38581.0, "minimum": 27414.4594, "maximum": 113363.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 46298.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35757.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 45498.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 44642.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 44855.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 32351.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 50119.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 61825.53 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 48227.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 54014.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 62502.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 49368.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 36941.39 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 59801.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 105427.92 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 31841.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37459.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35757.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35757.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 57872.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 35076.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35757.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38581.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38581.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65564.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34054.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 38581.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113363.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35076.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11911.92, "maximum": 12507.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12507.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5549.66, "maximum": 5827.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5827.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17943.17, "maximum": 18840.33, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18840.33, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9349.49, "maximum": 9816.96, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9816.96, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2144.52, "maximum": 2251.74, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2251.74, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4965.55, "maximum": 5213.83, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5213.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17063.0, "minimum": 11943.7358, "maximum": 41191.84, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20476.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15845.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 19822.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 19449.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19542.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 14336.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 21835.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 26935.71 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21329.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23888.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 27642.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21508.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16094.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15242.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 26448.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38308.41 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13714.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16600.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15845.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25595.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15543.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17063.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17063.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17063.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41191.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15543.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Anticoagulant Sodium Citrate Soln 4%", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "70092114843", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Ankle arthroscopysurgery", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12901.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 10707.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 581.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 581.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12901.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 10707.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8392.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 581.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 581.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8392.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13048.0, "minimum": 8840.21, "maximum": 36851.8862, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15658.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12130.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 15031.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14749.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14819.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10975.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 16558.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 20426.09 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16310.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18268.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 21138.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16310.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12204.8 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11668.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20225.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33577.56 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8840.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12708.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12130.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12130.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19573.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11899.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12130.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13048.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13048.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15709.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11553.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13048.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36104.9 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.59, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5680.2, "maximum": 5964.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5964.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Amputation Of Toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10264.0, "discounted_cash": 3489.0, "minimum": 180.79, "maximum": 8519.12, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5988.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.79 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1852.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8130.42, "maximum": 8536.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8536.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18008.02, "maximum": 18908.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18908.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19153.79, "maximum": 20111.48, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20111.48, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4384.69, "maximum": 4603.93, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4603.93, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12076.0, "minimum": 8357.9968, "maximum": 31804.1197, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14491.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11230.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 13871.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 13610.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13675.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10161.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 15280.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 18849.09 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15095.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16906.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19563.35, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15051.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11262.53 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10802.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18718.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20502.94 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8938.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11765.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11230.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11230.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18114.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11016.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11230.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12076.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12076.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15273.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12076.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22046.17 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11016.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7166.04, "maximum": 7524.34, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37962.0, "minimum": 4252.5, "maximum": 67341.4169, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 45555.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35184.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 44759.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 43917.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 44127.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 31833.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 49305.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 60821.72 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 47453.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 53147.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 61499.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 48566.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 36341.61 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33843.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 58842.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 29540.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36859.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35184.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35184.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56943.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 34514.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35184.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37962.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37962.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7796.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33508.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37962.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34514.17, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23889.0, "discounted_cash": 3489.0, "minimum": 785.0, "maximum": 19827.87, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9807.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9600.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 5150.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3083.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3083.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 832.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 832.69 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2935.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9807.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20841.0, "minimum": 7542.8784, "maximum": 56981.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 25009.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19341.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 24329.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 23872.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23986.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 17499.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 26801.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 33060.8 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 26051.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 29177.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 33762.7, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26399.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 19754.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18604.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 32303.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52992.85 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 16804.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20262.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19341.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19341.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31261.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18972.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19341.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20841.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20841.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29860.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20841.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 56981.56 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18972.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10535.58, "maximum": 11062.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11062.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6841.35, "maximum": 7183.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7183.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Arthrp ntrcrpl/crp/mtcrp ssp", "code_information": [ { "code": "25448", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13551.26, "discounted_cash": 3489.0, "minimum": 918.98, "maximum": 11247.5458, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3083.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3083.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.98 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13551.3, "discounted_cash": 3489.0, "minimum": 918.98, "maximum": 11247.5458, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3083.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3083.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.98 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2936.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6685.0, "minimum": 4482.3334, "maximum": 26613.4076, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8022.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6242.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7439.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7299.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7333.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5648.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8194.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10108.63 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8356.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9359.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10830.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8071.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6040.01 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6004.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10362.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11260.77 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4957.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6539.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6242.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6242.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10028.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6123.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6242.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7503.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12108.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6123.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16002.0, "discounted_cash": 7737.0, "minimum": 488.0, "maximum": 16002.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7367.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7212.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2107.88 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2107.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.61 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2006.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16002.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 16002.0, "discounted_cash": 7737.0, "minimum": 488.0, "maximum": 16002.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7367.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7212.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2107.88 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2107.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.61 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2006.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16002.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12803.84, "maximum": 13444.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13444.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHRT ELBW CAPSL EXC RLS", "code_information": [ { "code": "24006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4854.8, "discounted_cash": 3489.0, "minimum": 690.0, "maximum": 4854.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4854.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4854.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4854.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.46 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4854.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4854.8, "discounted_cash": 3489.0, "minimum": 690.0, "maximum": 4854.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4854.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4854.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4854.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.46 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4854.8, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4854.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8633.17, "maximum": 9064.83, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9064.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5548.0, "maximum": 5825.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.4, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3458.51, "maximum": 3631.44, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3631.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 2", "code_information": [ { "code": "0082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56602.4, "maximum": 59432.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 59432.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8012.48, "maximum": 8413.1, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8413.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 67651.64, "maximum": 71034.22, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 71034.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5489.52, "maximum": 5763.99, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5763.99, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Artery-Vein Nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21491.3, "discounted_cash": 5933.0, "minimum": 690.0, "maximum": 17837.779, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11064.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.31 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11064.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Av Fistula Revision Open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20990.3, "discounted_cash": 5933.0, "minimum": 690.0, "maximum": 17421.949, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11064.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 835.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 835.76 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11064.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10624.68, "maximum": 11155.91, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11155.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Artery-Vein Autograft", "code_information": [ { "code": "36825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25146.0, "discounted_cash": 5933.0, "minimum": 690.0, "maximum": 20871.18, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11064.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 878.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 878.61 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11064.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthrp W/Prostc Dst Rds&Crps", "code_information": [ { "code": "25446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36581.0, "discounted_cash": 18697.0, "minimum": 1199.51, "maximum": 36581.0, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 8223.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8227.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36581.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23371.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31427.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19258.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22436.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3794.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 28981.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8227.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 17762.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8227.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 25241.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26176.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30289.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28981.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8227.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31427.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21502.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30766.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8227.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20567.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 6232.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8638.9 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28046.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8638.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 19258.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19632.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1199.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1199.51 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18697.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Av Fuse Uppr Arm Basilic", "code_information": [ { "code": "36819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23440.2, "discounted_cash": 5933.0, "minimum": 558.0, "maximum": 19455.366, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11064.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 810.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 810.48 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11064.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANTERIOR COLPORRHAPHY, REPAIR CYSTOCELE", "code_information": [ { "code": "57240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16675.4, "discounted_cash": 5334.0, "minimum": 617.86, "maximum": 13840.5654, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8641.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 4401.51, "10th_percentile": 4401.51, "90th_percentile": 4401.51, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6134.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.86 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11794.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 16675.38, "discounted_cash": 5334.0, "minimum": 617.86, "maximum": 13840.5654, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8641.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 4401.51, "10th_percentile": 4401.51, "90th_percentile": 4401.51, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6134.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.86 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11794.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Artesunate For Iv Soln 110 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "73607001111", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "ASTHMA - SOI : 2", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3806.06, "maximum": 3996.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3996.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Av Fuse Uppr Arm Cephalic", "code_information": [ { "code": "36818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29829.0, "discounted_cash": 5933.0, "minimum": 558.0, "maximum": 24758.07, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11064.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 763.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 763.97 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11064.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 61542.0, "minimum": 17010.0, "maximum": 99698.6718, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 73850.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 57003.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 72895.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 71524.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 71865.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 51574.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 80299.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 99054.21 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 76927.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 86159.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 99698.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 79095.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 59185.91 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 54831.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 95390.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 47339.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 59717.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 57003.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 57003.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 92313.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 55917.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57003.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 61542.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 61542.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17150.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54289.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 61542.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 55917.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11340.0, "maximum": 38550.6415, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20965.72 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20524.34 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 12472.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22162.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22069.18 } ] } ] }, { "description": "Av Fusion Direct Any Site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20000.8, "discounted_cash": 3367.0, "minimum": 558.0, "maximum": 16600.664, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4040.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4545.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4713.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5454.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5218.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11064.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3872.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3703.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5050.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 731.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 731.77 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4208.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11064.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111.0, "discounted_cash": 6903.0, "minimum": 721.73, "maximum": 15111.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8284.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 10700.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6558.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9319.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9664.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11183.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10700.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7938.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7593.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3475.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10355.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3475.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7110.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7248.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721.73 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3308.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15111.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8629.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6903.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7110.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4577.25, "maximum": 4806.11, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4806.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11079.0, "minimum": 6542.1864, "maximum": 32612.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13295.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10308.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12682.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12443.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12502.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9326.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13970.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 17233.21 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13849.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15511.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17948.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13760.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10297.02 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9915.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17173.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30981.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30329.69 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8259.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10799.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10308.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10308.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16619.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10112.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10308.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11079.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11079.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11079.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32612.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10112.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13895.0, "minimum": 8505.0, "maximum": 29725.9, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16674.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12913.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 16041.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 15740.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15815.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 11684.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 17671.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 21798.58 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17369.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19453.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 22510.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17406.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13024.88 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21537.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10743.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13528.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12913.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12913.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20842.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12667.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12913.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13895.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29725.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13895.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12667.97, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6430.0, "minimum": 4299.0552, "maximum": 20111.9354, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7716.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6006.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7134.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7000.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7034.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5434.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7859.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9695.3 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8038.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9002.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10417.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7741.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5793.04 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5777.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9967.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18032.21 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4774.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6292.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6006.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6006.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9645.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5892.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6006.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6430.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5921.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5720.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6430.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19389.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5892.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21723.0, "minimum": 14458.5, "maximum": 35191.5516, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26067.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20157.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 25382.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 24904.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25023.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 18237.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 27960.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 34490.89 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27153.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 30412.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 35191.55, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27541.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 20608.67 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19389.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 33670.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 17592.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21117.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20157.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20157.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32584.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19773.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20157.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21723.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21723.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33058.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 21723.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19773.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Atracurium Besylate Preservative Free (Pf) Iv Soln 50 Mg/5Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409110901", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Azithromycin Tab 250 Mg", "drug_information": { "unit": 30.0, "type": "EA" }, "code_information": [ { "code": "59762219807", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 184.01, "10th_percentile": 184.01, "90th_percentile": 184.01, "count": "1 through 10" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10618.0, "minimum": 5386.5, "maximum": 19120.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12742.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9881.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12132.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11903.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11960.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8940.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13364.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16485.75 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13273.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14865.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17202.07, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13164.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9850.41 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9505.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16458.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7978.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10352.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8550.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9881.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9881.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15927.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9693.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9881.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10618.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10618.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19120.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10618.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9693.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 1", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42534.69, "maximum": 44661.42, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 44661.42, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 4", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 107437.19, "maximum": 112809.05, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 112809.05, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Azithromycin Tab 600 Mg", "drug_information": { "unit": 30.0, "type": "EA" }, "code_information": [ { "code": "69452017313", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 184.01, "10th_percentile": 184.01, "90th_percentile": 184.01, "count": "1 through 10" } ] } ] }, { "description": "Arthrd Ant Ntrbdy Cervical", "code_information": [ { "code": "22551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35845.0, "discounted_cash": 13690.0, "minimum": 1969.6, "maximum": 30270.2483, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16428.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3185.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 21220.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9964.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9964.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 18482.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19167.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22179.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21220.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9964.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15744.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9964.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15059.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10462.59 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20536.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10462.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14375.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1969.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 9959.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9964.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30270.25, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17113.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48702.0, "minimum": 34690.6678, "maximum": 78897.5478, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47270.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45121.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73053.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 44262.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48702.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48702.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 76150.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48702.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44262.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58442.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45121.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 57574.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 56491.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 56760.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 40824.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 63422.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 78234.95 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 60877.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68183.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 78897.55, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 62471.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 46746.19 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43403.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75488.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 42854.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 42973.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Av Fusion/Forearm Vein", "code_information": [ { "code": "36820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111.0, "discounted_cash": 5933.0, "minimum": 558.0, "maximum": 13119.5876, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7120.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8010.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8307.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9612.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9197.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11064.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6823.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8900.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3203.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6230.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 807.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 807.45 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3049.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3051.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13119.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7417.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11064.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18217.0, "minimum": 9072.0, "maximum": 29512.107, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21860.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16913.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 21199.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 20800.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20899.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15302.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 23352.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 28806.5 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22771.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25504.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 29512.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23002.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17212.18 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28236.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 14000.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17718.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16913.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16913.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27326.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16591.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16913.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18217.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18217.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16108.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18217.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16591.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Si Jt Perq/Min Nvas", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18442.0, "discounted_cash": 18697.0, "minimum": 876.01, "maximum": 18442.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 17762.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10657.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 876.01 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 10144.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10149.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18442.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOTRANSPLANT PARATHYROID", "code_information": [ { "code": "60512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15645.4, "minimum": 251.65, "maximum": 12985.682, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3932.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3932.42 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.65 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3743.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 } ] }, { "setting": "outpatient", "gross_charge": 15645.4, "minimum": 251.65, "maximum": 12985.682, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3932.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3932.42 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.65 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3743.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3745.16 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13720.0, "minimum": 5670.0, "maximum": 36632.3626, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16464.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12752.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 15833.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 15535.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15609.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 11537.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 17441.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 21514.86 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17150.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19208.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 22226.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17179.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12855.35 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12266.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21266.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10175.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13359.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12752.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12752.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20580.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12509.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12752.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13720.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13720.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19844.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12144.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13720.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 1", "code_information": [ { "code": "1411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2530.17, "maximum": 2656.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2530.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2530.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2530.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2530.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2530.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2656.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2530.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13735.09, "maximum": 14421.84, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13735.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 13735.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13735.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 13735.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 13735.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14421.84, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13735.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASTHMA - SOI : 4", "code_information": [ { "code": "1414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8044.08, "maximum": 8446.28, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8044.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8044.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8044.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8044.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8044.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8446.28, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8044.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23360.0, "minimum": 11803.8336, "maximum": 38501.03, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 28032.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 27335.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 26821.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26949.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 19608.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 30112.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 37145.15 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 29200.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32704.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 37843.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29660.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 22194.61 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20846.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 36208.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36575.98 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35805.96 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 17020.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 22704.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35040.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21259.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22137.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 23360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38501.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21259.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 1", "code_information": [ { "code": "7581", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2483.61, "maximum": 2607.79, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2483.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2483.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2483.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2483.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2483.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2483.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53120.0, "minimum": 37867.0642, "maximum": 86054.7726, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 63744.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 49210.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 62846.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 61663.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 61957.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 44523.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 69229.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 85398.41 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 66400.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 74368.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 86054.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 68191.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 51026.43 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 47335.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 82336.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 42854.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 51553.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 49210.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 49210.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 79680.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 48272.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49210.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 53120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57091.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46866.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 53120.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 48272.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Azithromycin For Susp 200 Mg/5Ml", "drug_information": { "unit": 23.0, "type": "ML" }, "code_information": [ { "code": "59762313001", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 184.01, "10th_percentile": 184.01, "90th_percentile": 184.01, "count": "1 through 10" } ] } ] }, { "description": "Aztreonam For Inj 2 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00003257016", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Aztreonam For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00003256016", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33646.0, "minimum": 15309.0, "maximum": 54507.7188, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 47105.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 54507.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 42978.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 32160.33 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 30002.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 52152.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 25446.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 32675.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31190.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50470.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 30596.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33646.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33646.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37454.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33646.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 30596.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 40376.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31190.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 39609.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 38864.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 39050.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 28220.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 43632.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 53823.88 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 42058.43, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "Bicarb 32 Meq/L-Dext Soln With K-Ca 2-3.5 Meq/L (Crrt)", "drug_information": { "unit": 5000.0, "type": "ML" }, "code_information": [ { "code": "24571010306", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 2", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12329.07, "maximum": 12945.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12329.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12329.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12329.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12329.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12329.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12945.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12329.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 1", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6215.67, "maximum": 6526.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6526.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24077.0, "minimum": 6237.0, "maximum": 39452.23, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 28893.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22336.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 28192.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 27661.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 27793.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 20209.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 31055.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 38308.81 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 30097.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 33709.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 39006.15, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 30590.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 22889.91 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 21485.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 37320.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37479.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36690.57 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 20332.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23399.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22336.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22336.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36116.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21910.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22336.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24077.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24077.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27009.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21272.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24077.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39452.23 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21910.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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", "discounted_cash": 32121.0, "minimum": 21262.5, "maximum": 71982.91, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38545.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29779.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 37790.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 37079.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 37255.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 26943.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 41628.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 51351.09 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 40152.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44970.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 52037.07, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41004.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 30682.81 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28645.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49788.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 68383.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 66944.11 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 24859.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31197.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29779.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29779.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48182.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 29212.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29779.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66291.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28361.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32121.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 71982.91 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29212.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31711.0, "minimum": 22474.8884, "maximum": 81069.9, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38053.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29399.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 37300.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 36598.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36773.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 26599.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 41089.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 50685.73 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 39639.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44395.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 51372.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 40473.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 30285.25 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28279.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49152.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 77016.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 75395.01 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 25905.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 30799.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29399.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29399.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 47566.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 28839.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29399.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31711.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31711.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37506.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 31711.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81069.9 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28839.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22989.79, "maximum": 24139.28, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24139.28, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22294.0, "minimum": 14742.0, "maximum": 51720.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26753.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20685.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 26063.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 25573.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25695.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 18715.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 28711.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 35416.93 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27867.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 31212.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 36116.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28280.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 21161.98 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19897.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 34556.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49134.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48100.31 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 16604.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21670.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20685.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20685.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33441.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20291.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20685.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22294.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22294.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22655.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19700.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22294.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51720.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20291.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Cervix", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988.2, "discounted_cash": 982.0, "minimum": 77.94, "maximum": 5800.206, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1325.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1375.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1591.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 849.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 831.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1080.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2171.58, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 849.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18884.0, "minimum": 5575.2, "maximum": 30592.728, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22661.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17530.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 21995.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 21581.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21684.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15861.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24229.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 29888.08 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23605.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26438.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 30592.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23865.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17858.43 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16862.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29270.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9315.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9119.22 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 12755.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18365.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17530.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17530.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28326.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17196.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17530.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18884.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18884.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13954.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16695.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18884.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9805.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17196.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23360.0, "minimum": 16470.7712, "maximum": 57017.65, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 28032.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 27335.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 26821.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26949.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 19608.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 30112.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 37145.15 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 29200.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32704.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 37843.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29660.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 22194.61 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20846.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 36208.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53026.41 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 17020.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 22704.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35040.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21259.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21672.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 23360.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57017.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21259.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Breast Open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8240.0, "discounted_cash": 4175.0, "minimum": 251.77, "maximum": 8240.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5010.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5636.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5845.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6763.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.64 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5652.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4801.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5533.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4592.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1211.32 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6262.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1211.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.77 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1153.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8240.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5219.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5652.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY OF CERVIX WSCOPE", "code_information": [ { "code": "57455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 324.0, "minimum": 112.65, "maximum": 4605.255, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 389.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 503.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 308.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 438.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 454.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 526.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 503.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 849.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 373.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 831.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 357.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 487.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 334.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.65 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.46, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 406.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 849.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 324.0, "minimum": 112.65, "maximum": 4605.255, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 389.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 503.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 308.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 438.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 454.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 526.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 503.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 849.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 373.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 831.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 357.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 487.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 334.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 341.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.65 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.46, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 406.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 849.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 2", "code_information": [ { "code": "7582", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3071.46, "maximum": 3225.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3225.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 4", "code_information": [ { "code": "7584", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7069.59, "maximum": 7423.07, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7423.07, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Biopsy of rectum", "code_information": [ { "code": "45100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6797.5, "discounted_cash": 2959.0, "minimum": 337.66, "maximum": 6544.2726, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3995.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4143.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4794.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6528.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6391.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3255.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4439.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.66 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1246.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6544.27, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3699.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6528.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6797.5, "discounted_cash": 2959.0, "minimum": 337.66, "maximum": 6544.2726, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3995.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4143.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4794.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6528.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6391.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3255.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4439.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.66 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1246.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6544.27, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3699.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6528.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38500 - OR36038500", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12848.0, "discounted_cash": 4175.0, "minimum": 285.75, "maximum": 10663.84, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6233.71 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5010.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5636.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5845.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6763.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6233.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4801.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4592.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2893.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6262.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2893.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.75 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2754.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9231.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5219.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 3", "code_information": [ { "code": "7583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5356.76, "maximum": 5624.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5356.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5356.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5356.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5356.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5356.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5624.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5356.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12555.7, "discounted_cash": 4175.0, "minimum": 435.15, "maximum": 10421.231, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5010.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5636.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5845.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6763.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6233.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4801.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4592.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2893.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6262.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2893.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 435.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 435.15 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2754.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9231.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5219.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6233.71 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38525 - OR36038525", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19818.3, "discounted_cash": 4175.0, "minimum": 488.0, "maximum": 16449.189, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5010.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5636.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5845.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6763.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 3108.41, "10th_percentile": 3108.41, "90th_percentile": 3108.41, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6233.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4801.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4592.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2893.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6262.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2893.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.48 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2754.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2755.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9231.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5219.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6233.71 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6864.0, "minimum": 4428.25, "maximum": 18926.2527, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8236.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6407.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7652.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7508.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7543.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5797.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8429.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10398.11 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8580.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9609.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11119.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8303.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6212.98 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6163.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10639.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14383.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14080.39 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5285.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6712.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6407.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6407.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10296.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6285.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6407.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6864.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6864.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4428.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6864.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15140.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6285.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10845.0, "minimum": 6255.408, "maximum": 17568.9972, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13014.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10091.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12402.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12169.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12227.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9130.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13662.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16853.0 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13556.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15183.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17569.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13457.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10069.84 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9707.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16809.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8964.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10572.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10091.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10091.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16267.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9899.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10091.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10845.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10845.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15929.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9610.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10845.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9899.31, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 3", "code_information": [ { "code": "7533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6344.13, "maximum": 6661.34, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6344.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6344.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6344.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6344.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6344.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6661.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6344.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 2", "code_information": [ { "code": "7532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3581.57, "maximum": 3760.65, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3760.65, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bone Biopsy Open Deep", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10660.5, "discounted_cash": 3097.0, "minimum": 350.43, "maximum": 8848.215, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.43 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 4", "code_information": [ { "code": "7534", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12037.22, "maximum": 12639.08, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12639.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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", "discounted_cash": 19790.0, "minimum": 13041.0, "maximum": 52785.84, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23748.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18368.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 23076.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 22642.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22750.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 16619.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 25419.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 31357.06 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24738.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27706.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 32060.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25038.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 18736.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17669.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30675.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50146.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49090.83 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 14885.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19243.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18368.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18368.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29685.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18019.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18368.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30794.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17494.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52785.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18019.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 3", "code_information": [ { "code": "1323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5652.76, "maximum": 5935.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5652.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5652.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5652.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5652.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5652.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5935.4, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5652.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31135.0, "minimum": 22061.0756, "maximum": 87745.43, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 37362.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28867.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 36613.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 35924.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36096.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 26117.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 40332.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 49752.49 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 38919.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 43590.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 50439.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 39727.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 29727.63 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 27767.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 48260.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83358.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81603.25 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 24416.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 30241.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28867.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 28867.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46703.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 28317.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28867.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31135.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31135.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50772.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27492.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 31135.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 87745.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28317.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Breast reconstruction", "code_information": [ { "code": "19350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16913.3, "discounted_cash": 4175.0, "minimum": 690.0, "maximum": 14038.0058, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5010.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5636.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5845.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6763.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5652.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4801.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5533.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4592.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4898.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2962.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6262.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2962.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.54 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2819.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9231.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5219.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5652.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 16913.26, "discounted_cash": 4175.0, "minimum": 690.0, "maximum": 14038.0058, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5010.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5636.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5845.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6763.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6471.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5652.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4801.58, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5533.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4592.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4898.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2962.05 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6262.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2962.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4384.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.54 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2819.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2821.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9231.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5219.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5652.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7824.0, "minimum": 5301.0186, "maximum": 16870.1334, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9389.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7296.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8797.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8632.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8673.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6601.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9691.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11954.94 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9780.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10953.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12675.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9546.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7143.2 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12127.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12814.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12544.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5925.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7643.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7296.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11736.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7157.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7824.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7824.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6321.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7824.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13489.02 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7157.25, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy Of Prostate", "code_information": [ { "code": "55700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12987.4, "discounted_cash": 2138.0, "minimum": 488.0, "maximum": 10779.542, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2565.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3314.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2245.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2031.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2886.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2993.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3463.8, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3314.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1649.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2458.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1614.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2351.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2245.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2245.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3207.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2202.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2245.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1475.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4727.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2672.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1649.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2202.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49507.0, "minimum": 20128.5, "maximum": 97855.68, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59409.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45867.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 58535.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 57434.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 57708.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 41499.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 64481.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 79541.2 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 61884.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 69310.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 80202.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 63514.5 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 47526.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 44120.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 76737.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 92962.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91005.78 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 43570.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 48051.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45867.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45867.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 74261.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 44993.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45867.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 49507.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49507.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77422.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49507.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 97855.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44993.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy of tear sac", "code_information": [ { "code": "68525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4368.0, "discounted_cash": 2535.0, "minimum": 223.25, "maximum": 4368.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3042.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3929.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2408.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3422.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3549.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4107.14, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3929.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4368.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2915.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2788.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1204.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3802.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1204.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2611.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.25 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1146.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3169.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2611.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4368.0, "discounted_cash": 2535.0, "minimum": 223.25, "maximum": 4368.0, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3802.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1204.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2611.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.25 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1146.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3169.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2611.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3042.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3929.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2408.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3422.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3549.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4107.14, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3929.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4368.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2915.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2788.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2535.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2662.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1204.27 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14553.0, "minimum": 9355.5, "maximum": 33868.28, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17464.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13522.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 16827.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 16510.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16589.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12235.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 18536.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 22865.75 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18191.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20374.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23576.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18258.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13662.52 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13007.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22557.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32174.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31497.5 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11012.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14166.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13522.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13522.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21830.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13265.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13522.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14553.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14553.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23560.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12879.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14553.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33868.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13265.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Brilliant Blue G Intraocular Soln Pref Syr 0.025%", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "68803072205", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 1", "code_information": [ { "code": "1321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2562.6, "maximum": 2690.73, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2562.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2562.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2562.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2562.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2562.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2690.73, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2562.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Biopsy of throat", "code_information": [ { "code": "42800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2842.8, "discounted_cash": 1654.0, "minimum": 115.89, "maximum": 2842.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1985.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2233.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2316.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2680.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 2842.8 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2213.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1902.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2167.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1820.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2481.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2842.8, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2068.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2213.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 2842.8, "discounted_cash": 1654.0, "minimum": 115.89, "maximum": 2842.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1985.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2233.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2316.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2680.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 2842.8 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2213.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1902.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2167.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1820.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2481.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2842.8, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2068.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2213.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16962.0, "minimum": 9355.5, "maximum": 28782.15, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20354.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15752.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 19701.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 19330.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19423.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 14251.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 21702.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 26771.52 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21202.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23747.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 27478.89, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21377.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 15996.26 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15151.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 26291.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27343.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26767.4 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 12608.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16502.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15752.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15752.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25443.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15451.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15752.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19036.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15001.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28782.15 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15451.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 3", "code_information": [ { "code": "1383", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4407.63, "maximum": 4628.01, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4407.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4407.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4407.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4407.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4407.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4628.01, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4407.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 4", "code_information": [ { "code": "1324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9006.09, "maximum": 9456.39, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9006.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9006.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9006.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9006.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9006.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9456.39, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9006.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Biopsy Of Vulva/Perineum", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10726.0, "discounted_cash": 982.0, "minimum": 60.29, "maximum": 8902.58, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1325.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1375.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1591.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1199.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1080.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.29 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2171.58, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy finger joint lining", "code_information": [ { "code": "26110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 1714.0, "minimum": 349.1, "maximum": 4736.09, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2057.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2657.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1628.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2314.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2400.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2777.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2657.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4736.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1971.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1886.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1442.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2572.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1130.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3791.22, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2143.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4736.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 1714.0, "minimum": 349.1, "maximum": 4736.09, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2057.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2657.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1628.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2314.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2400.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2777.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2657.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4736.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1971.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1886.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1442.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2572.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.1 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1130.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3791.22, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2143.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4736.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9077.0, "minimum": 6202.0832, "maximum": 23369.053, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10892.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8455.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10293.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 10099.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10147.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7650.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11338.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13987.04 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11346.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12708.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14705.53, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11168.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8357.4 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8133.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14070.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14022.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13727.61 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6863.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8858.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8455.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13616.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8294.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9077.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9077.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8314.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8053.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9077.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14760.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8294.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 1", "code_information": [ { "code": "0561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3967.78, "maximum": 4166.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4166.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Biopsy Vaginal Mucosa Simple", "code_information": [ { "code": "57100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6731.5, "discounted_cash": 982.0, "minimum": 68.3, "maximum": 5587.145, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1325.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1375.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1591.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1952.38 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1911.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1080.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.3 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2171.58, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1952.38 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy of tongue", "code_information": [ { "code": "41105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3698.74, "discounted_cash": 3535.0, "minimum": 109.75, "maximum": 3698.74, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3358.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 3698.74 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3698.74 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 3698.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.75 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3698.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 3698.74 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7798.38, "maximum": 8188.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7798.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7798.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7798.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7798.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7798.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8188.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7798.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIOPSY VRT BDY OPEN LMBRCRV", "code_information": [ { "code": "20251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6055.0, "discounted_cash": 7737.0, "minimum": 495.19, "maximum": 6055.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6055.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4277.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6055.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6055.0, "discounted_cash": 7737.0, "minimum": 495.19, "maximum": 6055.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6055.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4277.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6055.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6055.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.12, "discounted_cash": 3097.0, "minimum": 140.32, "maximum": 5548.12, "payers_information": [ { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5548.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5548.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.32 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5548.12, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5548.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19465.0, "minimum": 9639.0, "maximum": 36346.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23358.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18068.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 22688.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 22261.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22367.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 16347.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24992.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 30829.95 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24331.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27251.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 31533.8, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24618.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 18421.22 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17379.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30171.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22863.18 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22381.85 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 14536.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18928.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18068.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18068.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29197.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17723.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18068.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19465.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19465.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36346.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17207.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19465.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24066.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17723.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 1", "code_information": [ { "code": "7531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2651.56, "maximum": 2784.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2651.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2651.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2651.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2651.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2651.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2784.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2651.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11965.0, "minimum": 7191.9864, "maximum": 22897.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14358.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11127.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 13738.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 13480.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13544.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10068.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 15134.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 18669.07 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14956.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16751.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19383.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14907.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11154.96 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10703.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18545.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21752.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21294.74 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9272.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11657.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11127.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11127.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17947.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10915.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11127.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11965.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11965.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16477.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10598.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11965.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22897.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10915.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17585.0, "minimum": 6237.0, "maximum": 34380.3, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21102.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16328.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 20445.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 20060.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20156.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 14773.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 22522.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 27782.53 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21982.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 24620.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 28489.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22184.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16600.35 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15706.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27258.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19753.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19337.28 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 14094.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17106.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16328.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26378.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16017.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16328.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17585.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17585.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34380.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17585.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20792.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 2", "code_information": [ { "code": "0562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5663.57, "maximum": 5946.75, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5663.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5663.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5663.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5663.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5663.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5946.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5663.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 2", "code_information": [ { "code": "8422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12396.0, "maximum": 13015.8, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12396.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12396.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12396.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12396.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12396.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13015.8, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12396.0, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 3", "code_information": [ { "code": "3633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16365.03, "maximum": 17183.28, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16365.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 16365.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16365.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 16365.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 16365.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17183.28, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16365.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BONE MARROW HARVEST AUTOLOG", "code_information": [ { "code": "38232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8322.17, "discounted_cash": 4644.0, "minimum": 178.39, "maximum": 8322.17, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5573.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 7199.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4876.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1418.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 4412.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1418.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6270.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6502.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7524.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7199.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1418.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5341.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1418.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5109.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4876.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1489.1 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4876.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6966.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1489.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4783.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4876.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.39 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1417.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1418.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8322.17, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5805.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4644.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4783.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bronch Ebus Samplng 3/> Node", "code_information": [ { "code": "31653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7494.0, "discounted_cash": 3975.0, "minimum": 240.78, "maximum": 15949.446, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4770.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6162.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5367.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5566.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6440.76, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6162.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4572.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4373.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5963.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.78 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3164.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7494.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4969.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BX DONE WCOLPOSCOPY ADDON", "code_information": [ { "code": "58110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.5, "minimum": 41.66, "maximum": 4605.255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 } ] }, { "setting": "outpatient", "gross_charge": 5548.5, "minimum": 41.66, "maximum": 4605.255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 } ] } ] }, { "description": "Breast Reduction", "code_information": [ { "code": "19318", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36497.0, "discounted_cash": 7080.0, "minimum": 690.0, "maximum": 30292.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8497.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 10975.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6263.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6726.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6263.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9559.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9913.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11470.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10975.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6263.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10847.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8142.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10619.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6263.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7788.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4898.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6576.8 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10621.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6576.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7293.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1113.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1113.8 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6260.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6263.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15655.76, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8851.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10847.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7293.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 2", "code_information": [ { "code": "1322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3364.97, "maximum": 3533.22, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3364.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3364.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3364.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3364.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3364.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3533.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3364.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6402.0, "minimum": 4278.62, "maximum": 12011.2593, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7682.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5980.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7101.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6967.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7000.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5410.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7822.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9649.21 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8002.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8963.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10371.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7705.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5765.5 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5752.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9923.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9417.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9219.14 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4945.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6265.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5980.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5980.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9603.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5866.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5980.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6402.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6402.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5373.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5695.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6402.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9913.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5866.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bronch Ebus Samplng 1/2 Node", "code_information": [ { "code": "31652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8668.63, "discounted_cash": 3975.0, "minimum": 217.88, "maximum": 15949.446, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4770.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6162.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5367.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5566.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6440.76, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 565.91, "10th_percentile": 565.91, "90th_percentile": 565.91, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6162.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4572.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4373.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5963.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.88 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3164.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8668.63, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4969.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12490.37, "maximum": 13114.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12490.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12490.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12490.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12490.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12490.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13114.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12490.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 1", "code_information": [ { "code": "1381", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1942.73, "maximum": 2039.87, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 1942.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 1942.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 1942.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 1942.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 1942.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2039.87, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1942.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 1", "code_information": [ { "code": "3631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7004.74, "maximum": 7354.98, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7354.98, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 2", "code_information": [ { "code": "1382", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2782.11, "maximum": 2921.22, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2782.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2782.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2782.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2782.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2782.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2921.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2782.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 2", "code_information": [ { "code": "3632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12893.22, "maximum": 13537.88, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12893.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12893.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12893.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12893.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12893.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13537.88, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12893.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 4", "code_information": [ { "code": "3634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20788.05, "maximum": 21827.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20788.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 20788.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20788.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 20788.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 20788.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 21827.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20788.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409175550", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 4", "code_information": [ { "code": "1964", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10286.56, "maximum": 10800.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10286.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10286.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10286.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10286.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10286.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10800.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10286.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.75% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "63323046037", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 4", "code_information": [ { "code": "1384", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9370.69, "maximum": 9839.22, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9839.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00409174929", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4493.0, "minimum": 2906.2686, "maximum": 16237.31, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 5392.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 4214.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 4823.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 4732.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 4755.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 3812.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 5313.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 6554.26 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 5616.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 6290.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 7279.23, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 5233.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 3916.24 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 4053.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 6964.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15425.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15100.7 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 3136.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 4414.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 4214.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 4214.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6740.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 4133.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4214.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 4493.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4493.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5572.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4013.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 4493.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16237.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 4133.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bronchoscopy W/Biopsy(S)", "code_information": [ { "code": "31625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7356.0, "discounted_cash": 1898.0, "minimum": 154.45, "maximum": 7459.9155, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2562.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2657.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3074.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2791.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2847.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.45 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4196.52, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2791.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 2", "code_information": [ { "code": "2012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3869.67, "maximum": 4063.15, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4063.15, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 3", "code_information": [ { "code": "8423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23383.9, "maximum": 24553.1, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23383.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 23383.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23383.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 23383.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 23383.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24553.1, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23383.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bronchoscopy/Needle Bx Each", "code_information": [ { "code": "31629", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21478.0, "discounted_cash": 3975.0, "minimum": 184.94, "maximum": 17826.74, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4770.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 6162.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5367.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5566.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6440.76, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 565.91, "10th_percentile": 565.91, "90th_percentile": 565.91, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6162.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2791.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4572.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4373.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5963.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8790.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4969.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2791.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 1", "code_information": [ { "code": "8421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7992.11, "maximum": 8391.72, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8391.72, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 3", "code_information": [ { "code": "2013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5779.15, "maximum": 6068.11, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5779.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5779.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5779.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5779.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5779.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6068.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5779.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.25% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323046817", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 4", "code_information": [ { "code": "8424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56702.23, "maximum": 59537.34, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 56702.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 56702.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 56702.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 56702.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 56702.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 59537.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 56702.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6985.0, "minimum": 4698.1802, "maximum": 18257.11, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8382.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6520.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7797.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7650.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7687.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5899.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8589.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10595.41 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8732.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9780.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11316.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8460.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6330.87 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6271.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10827.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17344.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16979.11 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5249.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6830.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10350.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6520.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6520.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10478.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6396.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6520.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6985.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6985.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6034.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6985.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18257.11 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6396.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cabg Arterial Single", "code_information": [ { "code": "33533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37066.0, "minimum": 2119.18, "maximum": 30764.78, "payers_information": [ { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2119.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2119.18 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15120.18 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11145.0, "minimum": 6081.2616, "maximum": 33125.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13374.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10369.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12760.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12520.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12580.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9381.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 14056.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 17339.78 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13931.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15603.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 18055.35, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13846.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10360.7 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17275.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31469.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30806.95 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8561.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10863.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10369.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10369.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16717.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10171.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10369.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11145.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11145.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10901.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11145.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33125.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10171.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Bx Of Cervix W/Scope Leep", "code_information": [ { "code": "57460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12100.5, "discounted_cash": 3451.0, "minimum": 163.19, "maximum": 10043.415, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4353.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4261.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4353.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 1", "code_information": [ { "code": "1911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6195.71, "maximum": 6505.5, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6195.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6195.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6195.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6195.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6195.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6505.5, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6195.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Calcium Chloride Inj 10%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "76329330401", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Caffeine & Sodium Benzoate Inj 125-125 Mg/Ml (500 Mg/2Ml)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00517250201", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Cabg Vein Single", "code_information": [ { "code": "33510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59028.5, "minimum": 2186.66, "maximum": 48993.655, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15127.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15127.78 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15127.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15127.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15884.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15884.17 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2186.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2186.66 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15120.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15127.78 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 1", "code_information": [ { "code": "1921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6646.37, "maximum": 6978.69, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6646.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6646.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6646.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6646.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6646.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6978.69, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6646.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Carboprost Tromethamine Im Soln 250 Mcg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "43598069858", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 4", "code_information": [ { "code": "1924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18022.99, "maximum": 18924.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18022.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 18022.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18022.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 18022.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 18022.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18924.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18022.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 1", "code_information": [ { "code": "1961", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2482.78, "maximum": 2606.92, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2482.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2482.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2482.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2482.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2482.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2606.92, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2482.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 1", "code_information": [ { "code": "1771", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7963.84, "maximum": 8362.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8362.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 4", "code_information": [ { "code": "2014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9492.08, "maximum": 9966.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9492.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9492.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9492.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9492.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9492.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9966.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9492.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6082.0, "minimum": 3685.5, "maximum": 25678.32, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7298.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5684.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 6719.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6593.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6624.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5143.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7401.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9130.75 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7602.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8515.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9853.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7291.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5455.72 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5467.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9427.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24394.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23880.84 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5001.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5955.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5684.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5684.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9123.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5576.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5684.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6082.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6082.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8887.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5413.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6082.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25678.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5576.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Carbachol Intraocular Inj 0.01%", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00065002315", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 4", "code_information": [ { "code": "1774", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21313.54, "maximum": 22379.22, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21313.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 21313.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21313.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 21313.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 21313.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22379.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21313.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41473.0, "minimum": 14850.0, "maximum": 123900.0342, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 49768.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38433.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 48949.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 48028.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 48257.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 34773.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 53920.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 66514.76 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 51842.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 58063.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 67187.54, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 53112.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 39743.25 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36969.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 64284.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 33028.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40263.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38433.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38433.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 62210.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 37701.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38433.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 41473.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41473.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60895.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36603.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 41473.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37701.3, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14324.0, "minimum": 5670.0, "maximum": 36839.97, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17189.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13310.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 16553.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 16242.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16319.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12043.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 18235.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 22494.19 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17905.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20053.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23205.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17961.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13440.51 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12803.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22202.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34997.97 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34261.17 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11632.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13944.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13310.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13310.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21486.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13057.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13310.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14324.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14324.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26203.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12677.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14324.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36839.97 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13057.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 2", "code_information": [ { "code": "1962", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3672.61, "maximum": 3856.24, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3856.24, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28360.0, "minimum": 17519.4744, "maximum": 48458.4771, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 34032.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26298.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 33301.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 32675.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 32830.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 23794.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 36684.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 45251.93 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 35450.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 39704.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 45943.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36134.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 27038.49 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25296.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 43958.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 19919.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27551.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26298.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 26298.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42540.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 25797.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26298.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28360.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28360.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35395.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25046.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28360.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25797.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 2", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11496.35, "maximum": 12071.17, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11496.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11496.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11496.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11496.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11496.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12071.17, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11496.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 1", "code_information": [ { "code": "2011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2984.57, "maximum": 3133.8, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2984.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2984.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2984.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2984.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2984.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3133.8, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2984.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 3", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5719.7, "maximum": 6005.69, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6005.69, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45219.0, "minimum": 13950.0, "maximum": 130782.2916, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 54263.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41899.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 53418.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 52413.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 52663.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 37908.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 58844.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 72588.0 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 56524.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 63307.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 73255.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 57962.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 43372.08 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 40303.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 70090.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 72600.56 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 71072.13 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 32607.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43894.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41899.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 41899.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 67829.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 41101.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41899.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 45219.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45219.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39904.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 45219.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 76421.64 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41101.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17242.0, "minimum": 8505.0, "maximum": 31530.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20691.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16011.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 20036.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 19659.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19753.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 14486.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 22071.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 27226.62 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21553.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 24140.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 27933.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21740.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16268.19 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15401.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 26726.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25433.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24898.02 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13472.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16774.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16011.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16011.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25864.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15706.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16011.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17242.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17242.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31530.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17242.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26772.06 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15706.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5479.0, "minimum": 3615.1146, "maximum": 12568.99, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 6575.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5126.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 5999.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 5886.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 5915.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 4638.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 6609.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 8152.86 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 6849.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 7670.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 8876.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 6510.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 4871.42 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 4931.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 8492.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11940.54 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11689.16 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 3972.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5370.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5126.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5126.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8218.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5028.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5126.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5479.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5479.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5126.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4882.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5479.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12568.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5028.75, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 2", "code_information": [ { "code": "1912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7262.91, "maximum": 7626.06, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7262.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7262.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7262.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7262.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7262.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7626.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7262.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 2", "code_information": [ { "code": "2052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4114.12, "maximum": 4319.83, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4319.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29343.0, "minimum": 16159.5, "maximum": 67154.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 35211.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27208.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 34474.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 33826.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 33987.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 24617.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 37976.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 46846.21 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 36679.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 41080.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 47536.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 37407.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 27991.09 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 26172.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 45482.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61367.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 60075.75 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 24184.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 28504.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27208.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 27208.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 44014.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 26690.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27208.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29343.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29343.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 29343.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64597.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 26690.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 4", "code_information": [ { "code": "1914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13526.39, "maximum": 14202.71, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14202.71, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 3", "code_information": [ { "code": "1913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9432.22, "maximum": 9903.83, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9432.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9432.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9432.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9432.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9432.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9903.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9432.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 3", "code_information": [ { "code": "2053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6090.53, "maximum": 6395.06, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6090.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6090.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6090.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6090.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6090.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6395.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6090.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14928.0, "minimum": 5670.0, "maximum": 39021.5962, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17913.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13869.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17274.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 16949.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17030.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12548.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19029.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 23473.51 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18660.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20899.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24183.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18743.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14025.66 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13341.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23138.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18182.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17799.32 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10776.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14530.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13869.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13869.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22392.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13605.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13869.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14928.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14928.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19149.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13209.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14928.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19139.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13605.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 2", "code_information": [ { "code": "1922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8270.24, "maximum": 8683.75, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8270.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8270.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8270.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8270.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8270.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8683.75, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8270.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 3", "code_information": [ { "code": "1923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11598.2, "maximum": 12178.11, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11598.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11598.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11598.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11598.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11598.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12178.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11598.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17707.0, "minimum": 5400.0, "maximum": 28686.15, "payers_information": [ { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16718.24 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15815.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27446.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13015.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17224.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16441.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16441.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26561.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16128.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16441.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17707.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17707.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25581.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17707.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16128.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21249.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16441.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 20590.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 20203.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20299.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 14875.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 22682.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 27979.84 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22134.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 24790.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 28686.15, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15658.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22342.2 } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 1", "code_information": [ { "code": "2001", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2884.38, "maximum": 3028.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2884.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2884.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2884.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2884.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2884.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3028.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2884.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8562.0, "minimum": 4904.6904, "maximum": 16660.47, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10274.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7979.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9678.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9496.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9541.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7219.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10661.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13151.73 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11987.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13870.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10501.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7858.3 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7675.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13271.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15827.45 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15494.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6577.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7979.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7979.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12843.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7827.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7979.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8562.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8562.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10073.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8562.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16660.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7827.25, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14447.0, "minimum": 6374.1048, "maximum": 48230.01, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17337.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13425.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 16701.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 16386.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16465.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12146.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 18397.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 22694.37 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18059.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20226.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23405.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18121.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13560.12 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12913.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22393.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45818.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44853.91 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10631.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14064.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13425.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21671.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13169.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14447.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14447.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18891.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14447.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48230.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13169.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1623", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43458.13, "maximum": 45631.04, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43458.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 43458.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 43458.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 43458.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 43458.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 45631.04, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 43458.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 63785.0, "minimum": 37350.0, "maximum": 184191.1271, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 76542.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 59078.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 75571.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 74150.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 74503.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 53452.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 83247.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 102690.67 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 79731.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 89299.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 103331.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 81999.6 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 61358.73 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 56828.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 98867.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 50175.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 61892.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 59078.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 59078.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 95677.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 57953.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 59078.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 63785.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63785.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 74016.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 56265.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 63785.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 57953.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53803.0, "minimum": 27900.0, "maximum": 169590.9381, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 64563.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 49842.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 63661.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 62463.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 62761.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 45095.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 70127.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 86505.91 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 67254.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 75324.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 87161.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 69075.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 51688.17 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 47943.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 83395.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 43980.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 52215.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 49842.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 49842.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 80704.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 48892.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49842.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 53803.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53803.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42821.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47468.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 53803.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 48892.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 63450.46, "maximum": 66622.98, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 63450.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 63450.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 63450.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 63450.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 63450.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 66622.98, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 63450.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 3", "code_information": [ { "code": "1773", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15447.09, "maximum": 16219.44, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15447.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15447.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15447.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15447.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15447.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16219.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15447.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9582.3, "maximum": 10061.41, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9582.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9582.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9582.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9582.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9582.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10061.41, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9582.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25707.45, "maximum": 26992.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25707.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 25707.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25707.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 25707.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 25707.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 26992.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25707.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18411.0, "minimum": 10800.0, "maximum": 58730.7424, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22094.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17093.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 21431.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 21028.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21128.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15465.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 23608.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 29121.9 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23014.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25776.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 29827.23, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23254.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17400.64 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16442.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28538.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24747.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24226.28 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 12479.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17907.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17093.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27617.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16767.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18411.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18411.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16279.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18411.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26049.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16767.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58854.0, "minimum": 23400.0, "maximum": 197287.2088, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 70625.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 69688.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 68377.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 68703.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 49324.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 76766.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 94696.22 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 73568.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 82396.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 95344.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 75615.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 56581.97 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 52439.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 91224.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 118143.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 115656.27 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 45851.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 57112.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 88281.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 53478.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 58854.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58854.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59696.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 58854.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 124361.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 53478.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28446.32, "maximum": 29868.64, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28446.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 28446.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 28446.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 28446.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 28446.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 29868.64, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28446.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 2", "code_information": [ { "code": "2002", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4270.02, "maximum": 4483.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4270.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4270.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4270.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4270.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4270.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4483.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4270.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 87344.0, "minimum": 48150.0, "maximum": 242437.84, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 104813.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 80879.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 103683.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 101732.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 102217.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 73176.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 114214.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 140890.03 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 109180.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 122282.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 141498.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 112502.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 84183.24 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 77797.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 135383.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 230315.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 225467.19 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 68522.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 84730.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 80879.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 80879.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 131016.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 79338.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 80879.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 87344.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 87344.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 130454.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 77027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 87344.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 242437.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 79338.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 3", "code_information": [ { "code": "2003", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6175.34, "maximum": 6484.11, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6484.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47818.0, "minimum": 25200.0, "maximum": 140595.0624, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 57382.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 44304.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 56519.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 55456.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 55720.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 40084.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 62260.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 76801.97 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 59773.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 66945.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 77465.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 61327.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 45889.97 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 42616.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 74118.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 94913.59 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 92915.41 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 37606.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 46413.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 44304.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 44304.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 71727.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 43460.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44304.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 47818.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47818.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42194.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 47818.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99909.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 43460.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58854.0, "minimum": 10350.0, "maximum": 106528.73, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 70625.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 69688.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 68377.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 68703.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 49324.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 76766.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 94696.22 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 73568.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 82396.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 95344.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 75615.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 56581.97 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 52439.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 91224.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 101202.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99071.72 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 42240.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 57112.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 88281.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 53478.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54516.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 58854.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58854.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75058.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 58854.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 106528.73 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 53478.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 68651.0, "minimum": 38250.0, "maximum": 185313.7431, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 82382.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 63582.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 81378.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 79847.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 80228.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 57526.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 89644.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 110581.42 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 85814.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 96112.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 111215.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 88300.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 66073.54 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 61159.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 106410.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 147053.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 143957.3 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 54936.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 66609.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 63582.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 63582.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 102977.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 62370.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 63582.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 68651.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68651.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 86461.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 60554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 68651.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 154792.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 62370.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 1", "code_information": [ { "code": "3831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2880.22, "maximum": 3024.23, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2880.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2880.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2880.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2880.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2880.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3024.23, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2880.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29392.12, "maximum": 30861.73, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 29392.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 29392.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29392.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 29392.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 29392.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 30861.73, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29392.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34442.48, "maximum": 36164.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34442.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 34442.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 34442.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 34442.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 34442.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 36164.6, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34442.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 3", "code_information": [ { "code": "3833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5873.1, "maximum": 6166.76, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5873.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5873.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5873.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5873.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5873.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6166.76, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5873.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 53992.47, "maximum": 56692.09, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 53992.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 53992.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 53992.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 53992.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 53992.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 56692.09, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 53992.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35944.12, "maximum": 37741.33, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35944.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 35944.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35944.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 35944.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 35944.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 37741.33, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35944.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 2", "code_information": [ { "code": "3832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3947.41, "maximum": 4144.78, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3947.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3947.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3947.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3947.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3947.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4144.78, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3947.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 4", "code_information": [ { "code": "3834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10728.48, "maximum": 11264.9, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10728.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10728.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10728.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10728.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10728.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11264.9, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10728.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 1", "code_information": [ { "code": "2051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3301.78, "maximum": 3466.87, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3301.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3301.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3301.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3301.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3301.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3466.87, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3301.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 4", "code_information": [ { "code": "2054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10946.74, "maximum": 11494.08, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11494.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8186.0, "minimum": 5561.5674, "maximum": 18788.4123, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9823.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7631.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9230.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9056.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9099.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6904.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10167.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12542.54 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10233.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11461.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13262.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10015.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7494.29 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7340.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12689.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12007.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11754.78 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6253.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7994.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13950.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7631.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7631.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12279.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7486.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7631.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8186.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8186.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6492.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8186.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12639.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7486.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Care Of Miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9328.57, "discounted_cash": 3451.0, "minimum": 418.08, "maximum": 7742.7131, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1499.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1499.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 3772.72, "10th_percentile": 3772.72, "90th_percentile": 3772.72, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1499.52 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5429.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5315.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1499.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.5 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.08 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1498.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1499.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5429.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 3", "code_information": [ { "code": "5393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9317.45, "maximum": 9783.32, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9783.32, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 1", "code_information": [ { "code": "5401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5362.12, "maximum": 5630.22, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5630.22, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21684.0, "minimum": 8550.0, "maximum": 35128.242, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26020.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20121.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 25335.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 24859.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 24977.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 18204.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 27909.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 34427.53 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27105.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 30357.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 35128.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27490.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 20570.8 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19354.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 33610.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 16151.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21079.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20121.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20121.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32526.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19737.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20121.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21684.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21684.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31246.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19163.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 21684.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19737.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34831.0, "minimum": 21150.0, "maximum": 56427.2406, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 41797.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32287.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 41023.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 40251.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 40443.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 29212.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 45190.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 55745.09 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 43539.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 48764.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 56427.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 44513.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 33308.26 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 31057.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 53989.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 27609.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 33824.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32287.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 32287.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52247.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 31672.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32287.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 34831.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34831.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49061.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 34831.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 31672.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15102.0, "minimum": 9446.0, "maximum": 24465.7746, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18122.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14030.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17482.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 17153.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17235.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12694.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19257.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 23755.79 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18877.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21143.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24465.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18969.25 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14194.33 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13496.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23408.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11472.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14699.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18900.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 22500.0, "10th_percentile": 22500.0, "90th_percentile": 22500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14030.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14030.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22653.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13763.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14030.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15102.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15102.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13362.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15102.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13763.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 4", "code_information": [ { "code": "5404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15826.56, "maximum": 16617.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15826.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15826.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15826.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15826.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15826.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16617.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15826.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6552.18, "discounted_cash": 2082.0, "minimum": 468.29, "maximum": 5438.3094, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2498.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1167.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1167.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2811.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2915.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3373.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1167.59 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5233.31 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2394.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5123.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1167.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2290.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1225.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3123.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1225.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.29 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1167.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1167.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4604.01, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2602.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5233.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33427.25, "maximum": 35098.61, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33427.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 33427.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33427.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 33427.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 33427.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 35098.61, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33427.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22257.0, "minimum": 9446.0, "maximum": 36057.7818, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26709.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20652.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 26020.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 25530.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25652.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 18685.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 28663.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 35357.88 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27822.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 31161.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 36057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28233.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 21126.7 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19865.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 34499.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13078.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21635.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20652.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20652.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33386.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20258.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20652.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22257.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22257.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16544.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19668.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22257.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20258.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cauterization Of Cervix", "code_information": [ { "code": "57510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 3451.0, "minimum": 117.49, "maximum": 9210.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4353.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4261.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.49 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4353.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43124.0, "minimum": 18085.2336, "maximum": 69861.0744, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 51748.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39960.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 50918.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 49960.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 50198.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 36154.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 56090.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 69190.62 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 53905.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 60373.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 69861.07, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 55249.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 41342.11 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 38438.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 66842.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 35551.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41863.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39960.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39960.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64686.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 39199.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39960.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43124.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43124.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57829.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38057.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 43124.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 39199.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8958.0, "minimum": 6116.5108, "maximum": 14512.7214, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10750.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8345.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10151.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9960.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10007.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7550.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11182.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13794.05 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11198.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12541.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14512.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11014.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8242.09 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8027.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13885.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6201.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8743.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8345.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8345.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13437.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8186.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8345.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8958.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8958.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8661.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8958.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8186.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6846.0, "minimum": 4597.92, "maximum": 11175.59, "payers_information": [ { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6195.77 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6147.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10611.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10616.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10393.3 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5065.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6695.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6391.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10269.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6269.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6391.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6846.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6846.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7449.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6846.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11175.59 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6269.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8215.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6391.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7630.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7487.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7523.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5782.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8406.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10369.3 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8557.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9584.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11090.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6086.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8280.0 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 2", "code_information": [ { "code": "5392", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6686.37, "maximum": 7020.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6686.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6686.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6686.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6686.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6686.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6686.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cefiderocol Sulfate Tosylate For Iv Soln 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "59630026601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CHEST PAIN - SOI : 3", "code_information": [ { "code": "2033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4703.64, "maximum": 4938.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4938.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 384012.0, "minimum": 55350.0, "maximum": 622099.9584, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 460814.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 355395.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 457674.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 449063.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 451204.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 321548.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 504159.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 621910.48 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 480015.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 537617.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 622099.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 496602.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 371597.93 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 341856.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 595219.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 267760.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 372319.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 355395.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 355395.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 576018.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 348626.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 355395.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 384012.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 384012.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 412845.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 338472.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 384012.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 348626.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Change Of Bladder Tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.0, "discounted_cash": 266.0, "minimum": 52.56, "maximum": 5878.89, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 319.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 412.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 253.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 373.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 431.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 412.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 691.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 676.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 293.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 279.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 399.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 274.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.56 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 589.08, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 691.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5152.22, "maximum": 5409.83, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5152.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5152.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5152.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5152.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5152.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5409.83, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5152.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13075.0, "minimum": 7545.4776, "maximum": 33003.09, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15690.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12155.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 15063.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14780.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14850.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10997.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 16593.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 20469.29 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16344.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18305.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 21182.15, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16344.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12230.61 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11692.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20266.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31352.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30692.87 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10431.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12734.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12155.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12155.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19613.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11923.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12155.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13075.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13075.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14425.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13075.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33003.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11923.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10772.97, "maximum": 11311.62, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.62, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43340.0, "minimum": 20128.5, "maximum": 96394.39, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 52009.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40161.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 51177.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 50214.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 50453.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 36336.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 56375.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 69542.02 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 54176.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 60677.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 70212.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 55530.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 41552.07 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 38631.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 67178.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91574.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 89646.78 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 34486.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 42073.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40161.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 40161.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 65011.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 39396.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40161.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43340.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43340.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50070.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38248.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 43340.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 96394.39 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 39396.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23478.0, "minimum": 11334.2448, "maximum": 38034.8622, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 28173.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21781.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 27476.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 26959.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 27088.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 19707.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 30267.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 37336.69 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 29347.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32869.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 38034.86, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29813.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 22309.06 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20951.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 36391.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 18131.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 22818.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21781.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21781.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35217.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21366.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21781.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23478.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23478.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17724.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20744.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 23478.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21366.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 2", "code_information": [ { "code": "5402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6918.83, "maximum": 7264.77, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6918.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6918.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6918.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6918.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6918.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7264.77, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6918.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 4", "code_information": [ { "code": "2034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6985.61, "maximum": 7334.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6985.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6985.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6985.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6985.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6985.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7334.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6985.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8967.0, "minimum": 6122.8968, "maximum": 14527.107, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10760.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8354.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10161.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9970.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10018.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7558.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11193.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13808.46 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11209.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12554.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14527.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11026.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8250.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8035.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13899.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6423.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8751.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8354.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8354.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13451.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8194.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8354.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11292.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8967.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8194.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18808.0, "minimum": 12757.5, "maximum": 43588.01, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22569.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17459.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 21903.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 21491.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21594.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15797.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24128.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 29764.22 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23510.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26331.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 30468.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23767.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17784.43 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16794.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29152.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41408.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40536.85 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 14044.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18291.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17459.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17459.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28212.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17127.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17459.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18808.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18808.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25519.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16628.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18808.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43588.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17127.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3719.59, "maximum": 3905.57, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3719.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3719.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3719.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3719.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3719.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3905.57, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3719.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Chromic Chloride Inj 40 Mcg/10Ml (4 Mcg/Ml) (Elemental Cr)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409409301", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18991.0, "minimum": 12509.9496, "maximum": 30766.8456, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22790.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17630.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 22123.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 21707.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21810.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15950.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24370.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 30062.34 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23739.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26588.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 30766.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24005.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17962.56 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16958.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29437.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 14400.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18469.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17630.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17630.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28487.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17294.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17630.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18991.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18991.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17673.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16790.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18991.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17294.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHROMOTUBATION OF OVIDUCT,INC MATERIALS", "code_information": [ { "code": "58350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10369.26, "discounted_cash": 5334.0, "minimum": 92.08, "maximum": 10369.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8641.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6134.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10369.26, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 10369.3, "discounted_cash": 5334.0, "minimum": 92.08, "maximum": 10369.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8641.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6134.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10369.26, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32095.0, "minimum": 21546.0, "maximum": 70651.28, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38514.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29754.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 37758.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 37047.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 37224.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 26921.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 41593.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 51307.89 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 40118.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44933.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 51993.92, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 40969.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 30656.99 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28621.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49747.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 67118.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 65705.69 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 24876.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31171.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29754.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29754.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48142.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 29188.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29754.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32095.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32095.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44205.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28337.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32095.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 70651.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29188.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26619.0, "minimum": 7087.5, "maximum": 43122.9258, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 31942.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24687.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 31224.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 30636.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 30782.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 22336.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 34395.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 42429.17 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 33273.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 37266.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 43122.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33880.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 25351.87 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 23747.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 41259.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33438.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32734.54 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 20570.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 25863.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24687.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 24687.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39928.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 24217.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24687.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26619.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26619.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31341.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 26619.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35198.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 24217.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13276.0, "minimum": 9220.7454, "maximum": 41287.0287, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15931.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12341.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 15303.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 15015.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15086.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 11165.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 16857.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 20794.77 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16595.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18586.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 21507.35, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16604.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12425.09 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11870.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20578.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9729.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12928.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12341.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12341.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19914.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12106.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12341.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13276.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13276.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11690.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11753.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13276.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 1", "code_information": [ { "code": "4701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2588.79, "maximum": 2718.23, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2588.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2588.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2588.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2588.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2588.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2718.23, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2588.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29791.0, "minimum": 16159.5, "maximum": 64502.53, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 29791.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64502.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27097.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 35750.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27623.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 35010.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 34351.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 34515.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 24992.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 38566.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 47573.5 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 37239.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 41708.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 48262.76, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 37987.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 28425.66 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 26571.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 46177.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61277.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59987.35 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 19428.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 28939.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27623.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 27623.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 44687.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 27097.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27623.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29791.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29791.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22135.0, "minimum": 4536.0, "maximum": 35859.2184, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26562.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20538.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 25874.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 25387.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25508.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 18582.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 28502.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 35159.14 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27669.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 30989.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 35859.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28074.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 21007.95 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19756.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 34309.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28069.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27478.18 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 16808.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21516.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20538.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20538.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33202.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20147.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20538.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22135.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22135.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26778.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19560.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22135.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29546.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20147.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7995.0, "minimum": 5424.2684, "maximum": 34581.3485, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9594.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7454.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9002.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8833.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8875.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6744.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9916.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12232.9 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9994.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11193.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12952.92, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9768.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7309.28 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7170.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12393.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5814.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7809.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7454.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7454.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11993.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7312.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7454.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7995.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8283.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7995.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7312.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5825.71, "maximum": 6117.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6117.0, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 2", "code_information": [ { "code": "2632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9082.58, "maximum": 9536.71, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9082.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9082.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9082.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9082.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9082.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9536.71, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9082.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 3", "code_information": [ { "code": "5403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8623.4, "maximum": 9054.58, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8623.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8623.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8623.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8623.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8623.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9054.58, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8623.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 1", "code_information": [ { "code": "2031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3190.36, "maximum": 3349.88, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3190.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3190.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3190.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3190.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3190.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3349.88, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3190.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 4", "code_information": [ { "code": "4704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10203.82, "maximum": 10714.01, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10203.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10203.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10203.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10203.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10203.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10714.01, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10203.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9955.0, "minimum": 6833.6586, "maximum": 35084.4013, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11947.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9268.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11341.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11128.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11181.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8386.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12493.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 15411.38 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12444.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13938.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16128.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12306.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9208.46 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8915.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15431.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29366.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28748.51 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7736.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9710.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9268.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14933.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9092.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9955.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9955.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8827.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9955.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30912.38 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9092.25, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9867.0, "minimum": 6769.7986, "maximum": 15984.7344, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11840.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9186.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11235.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11024.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11076.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8311.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12376.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 15267.36 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12333.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13813.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 15984.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12191.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9122.4 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8836.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15294.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7689.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9624.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9186.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9186.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14800.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9011.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9186.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9867.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9867.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10438.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8749.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9867.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9011.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5343.87, "maximum": 5611.06, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5611.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Circumcision W/Regionl Block", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14688.0, "discounted_cash": 2229.0, "minimum": 95.06, "maximum": 12191.04, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6025.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5898.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1794.53 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1794.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.06 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1708.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6025.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 1", "code_information": [ { "code": "5391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5464.83, "maximum": 5738.07, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5464.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5464.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5464.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5464.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5464.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5738.07, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5464.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7903.14, "maximum": 8298.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7903.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7903.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7903.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7903.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7903.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8298.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7903.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6779.0, "minimum": 4550.025, "maximum": 15258.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8135.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6329.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7551.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7409.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7444.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5726.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8318.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10261.29 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8474.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9491.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10983.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8193.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6131.23 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6088.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10508.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14495.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14190.64 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4945.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6631.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6329.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6329.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10169.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6209.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6329.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6779.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6779.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7556.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6028.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6779.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15258.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6209.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 4", "code_information": [ { "code": "5394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21059.19, "maximum": 22112.15, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21059.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 21059.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21059.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 21059.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 21059.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22112.15, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21059.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7938.0, "minimum": 5383.398, "maximum": 22530.79, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9526.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7402.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8934.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8766.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8808.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6697.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9842.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12140.73 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9923.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11114.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12860.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9694.5 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7254.21 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7120.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12305.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21404.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20953.63 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6099.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7754.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7402.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11908.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7261.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7938.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9131.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7049.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7938.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22530.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7261.25, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "70069016110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10370.0, "minimum": 7131.8848, "maximum": 16800.615, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12444.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9652.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11836.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11613.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11669.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8733.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13038.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16083.94 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12963.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14519.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16800.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12843.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9610.32 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9284.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16074.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7538.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10112.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14850.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 45000.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9652.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9652.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15556.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9468.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9652.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10370.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10370.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15451.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10370.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9468.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19126.0, "minimum": 12474.0, "maximum": 50477.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22951.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17754.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 22283.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 21864.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21968.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 16063.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24546.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 30279.81 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23907.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26776.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 30984.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24178.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 18092.5 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29645.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47953.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46943.94 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 15134.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18599.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17754.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17754.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28689.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17415.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17754.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19126.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19126.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26893.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16908.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19126.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50477.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17415.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Chemodenervation Anal Musc", "code_information": [ { "code": "46505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7802.33, "discounted_cash": 1276.0, "minimum": 271.64, "maximum": 6475.9339, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1531.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1212.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1722.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1786.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2067.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1488.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1467.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1457.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1403.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1914.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 271.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 271.64 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1246.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2821.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1595.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1488.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15200.0, "minimum": 7938.0, "maximum": 39742.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18240.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14121.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17598.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 17267.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17350.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12776.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19386.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 23914.21 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19000.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21280.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24624.06, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19095.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14288.98 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13583.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23560.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37755.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36960.39 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11803.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14793.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14121.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14121.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22800.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13852.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14121.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15200.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15200.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20975.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15200.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39742.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13852.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 1", "code_information": [ { "code": "0951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5357.59, "maximum": 5625.47, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5357.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5357.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5357.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5357.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5357.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5625.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5357.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12070.0, "minimum": 7359.2016, "maximum": 19554.7284, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14484.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11225.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 13865.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 13604.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13669.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10156.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 15273.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 18840.45 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15088.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16899.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19554.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15044.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11257.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18709.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9021.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11760.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11225.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11225.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18106.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11011.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11225.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12070.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12070.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10271.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12070.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11011.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 1", "code_information": [ { "code": "2631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7165.21, "maximum": 7523.47, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7165.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7165.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7165.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7165.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7165.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7523.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7165.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 2", "code_information": [ { "code": "0952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6188.23, "maximum": 6497.64, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6497.64, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 2", "code_information": [ { "code": "2032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3773.64, "maximum": 3962.32, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3773.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3773.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3773.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3773.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3773.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3962.32, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3773.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 3", "code_information": [ { "code": "2633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11522.54, "maximum": 12098.67, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12098.67, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 2", "code_information": [ { "code": "4702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3525.44, "maximum": 3701.71, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3525.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3525.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3525.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3525.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3525.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3701.71, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3525.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cmplx Rpr S/A/L 2.6-7.5 Cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 433.0, "minimum": 235.73, "maximum": 9210.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 520.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 671.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 585.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 606.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 702.25, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 671.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 435.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 476.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 650.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.73 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 364.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 958.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 541.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 435.17 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Circum 28 Days Or Older", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.0, "discounted_cash": 2229.0, "minimum": 200.25, "maximum": 7078.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6025.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5898.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1794.53 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1794.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.25 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1708.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1709.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6025.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CLOSED TX NOSE FX W STABLJ", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8245.67, "discounted_cash": 3535.0, "minimum": 92.25, "maximum": 7816.9684, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4242.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5480.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 398.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3358.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 398.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4772.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4949.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5727.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5480.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 398.87 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2213.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2167.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 398.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3889.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.81 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5303.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 418.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.25 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 398.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 398.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7816.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4419.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2213.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 1", "code_information": [ { "code": "6611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4649.18, "maximum": 4881.64, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4881.64, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17933.0, "minimum": 12568.9252, "maximum": 34303.52, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21519.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16650.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 20860.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 20467.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20565.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15064.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 22978.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 28345.64 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22416.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25106.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 29051.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22634.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16936.81 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16016.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27796.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32588.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31902.27 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13909.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17443.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16650.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16650.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26899.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16333.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16650.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17933.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17933.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22516.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17933.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34303.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16333.23, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cltx Sho Dslc W/Mnpj W/Anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448.0, "discounted_cash": 1714.0, "minimum": 365.0, "maximum": 4550.0, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4278.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1971.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4188.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1886.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1442.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2572.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.2 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 836.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3791.22, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2143.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4278.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2057.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2657.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1800.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1628.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2314.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2400.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2777.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2657.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.98 } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 3", "code_information": [ { "code": "6613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7998.76, "maximum": 8398.7, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7998.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7998.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7998.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7998.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7998.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8398.7, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7998.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12560.0, "minimum": 7938.0, "maximum": 30471.74, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15072.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11678.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 14448.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14177.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14244.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10566.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 15916.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 19633.99 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15700.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17584.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20347.57, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15677.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11731.51 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11233.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19468.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28948.15 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28338.72 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9728.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12234.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11678.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11678.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18840.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11456.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11678.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12560.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12560.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25823.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12560.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30471.74 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11456.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Clear outer ear canal", "code_information": [ { "code": "69205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.4, "discounted_cash": 1761.0, "minimum": 95.35, "maximum": 7078.572, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.35 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 8528.4, "discounted_cash": 1761.0, "minimum": 95.35, "maximum": 7078.572, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.35 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13999.0, "minimum": 9740.5658, "maximum": 27143.0721, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16798.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13010.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 16165.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 15861.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15937.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 11771.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 17807.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 21967.08 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17498.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19598.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 22678.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17540.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13125.56 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12514.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21698.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18887.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18489.88 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10990.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13629.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13010.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13010.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20998.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12762.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13010.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13999.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13999.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14220.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13999.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19881.59 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12762.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 4", "code_information": [ { "code": "2634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21264.06, "maximum": 22327.26, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21264.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 21264.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21264.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 21264.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 21264.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22327.26, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21264.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 4", "code_information": [ { "code": "0954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14276.79, "maximum": 14990.63, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14276.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 14276.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14276.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 14276.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 14276.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14990.63, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14276.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7744", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11115.53, "maximum": 11671.31, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11115.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11115.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11115.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11115.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11115.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11671.31, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11115.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7743", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4745.21, "maximum": 4982.47, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4745.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4745.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4745.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4745.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4745.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4982.47, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4745.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3578.24, "maximum": 3757.15, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3578.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3578.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3578.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3578.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3578.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3757.15, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3578.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17879.0, "minimum": 12530.6092, "maximum": 39251.49, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21455.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16601.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 20796.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 20405.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20502.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15019.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 22908.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 28259.23 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22349.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25031.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 28965.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22565.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16885.18 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15968.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27713.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37288.92 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36503.89 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13662.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17391.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16601.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16601.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26819.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16284.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16601.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17879.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15810.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17879.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39251.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16284.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy W/Lesion Removal", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11608.0, "discounted_cash": 1276.0, "minimum": 246.84, "maximum": 9634.64, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1531.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1212.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1722.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1786.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2067.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2570.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1467.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2516.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1403.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1914.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.84 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 854.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2821.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1595.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2570.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4406.8, "maximum": 4627.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4627.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7562.0, "minimum": 5112.6316, "maximum": 19932.52, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9074.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7053.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8485.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8325.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8365.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6381.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9347.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11530.09 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9452.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10587.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12250.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9206.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6889.35 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6785.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11721.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18935.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18537.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5320.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7389.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7053.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11343.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6919.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7562.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6738.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7562.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19932.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6919.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Colpocleisis Le Fort Type", "code_information": [ { "code": "57120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19125.0, "discounted_cash": 5334.0, "minimum": 533.84, "maximum": 15873.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4804.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4804.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8641.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4804.58 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6134.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4804.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5044.81 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5044.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.84 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4802.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4804.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11794.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10289.0, "minimum": 7073.7722, "maximum": 27174.52, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12347.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9577.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11739.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11519.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11574.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8665.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12932.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 15952.88 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12862.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14405.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16669.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12738.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9532.01 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9212.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15949.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25815.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25272.3 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7973.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10033.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9577.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9577.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15434.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9395.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9577.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10289.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10289.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10263.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10289.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27174.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CMBN ANT PST COLPRHY", "code_information": [ { "code": "57260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21593.75, "discounted_cash": 5334.0, "minimum": 785.0, "maximum": 17922.8125, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8641.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6134.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11794.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 21593.8, "discounted_cash": 5334.0, "minimum": 785.0, "maximum": 17922.8125, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7201.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7468.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8641.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8268.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6134.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5867.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8001.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5601.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11794.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6668.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 2", "code_information": [ { "code": "0572", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5303.96, "maximum": 5569.16, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5303.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5303.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5303.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5303.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5303.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5569.16, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5303.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [ { "code": "57282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12623.4, "discounted_cash": 7907.0, "minimum": 699.65, "maximum": 12623.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9489.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10675.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11070.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12623.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12603.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9093.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8698.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11861.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.65 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12623.42, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12603.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12623.42, "discounted_cash": 7907.0, "minimum": 699.65, "maximum": 12623.42, "payers_information": [ { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12603.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9093.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8698.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11861.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.65 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12623.42, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12603.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9489.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10675.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11070.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12623.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6153.0, "minimum": 4099.812, "maximum": 15492.84, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7384.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5750.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 6804.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6676.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6708.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5202.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7495.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9245.96 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7691.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8614.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9968.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7383.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5524.56 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5531.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9537.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14718.2 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14408.34 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4595.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6024.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5750.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5750.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9230.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5640.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5750.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6153.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6153.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5691.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5476.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6153.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15492.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5640.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cmplx rpr fccmnaxghf", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7462.36, "discounted_cash": 433.0, "minimum": 274.72, "maximum": 6193.7588, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 520.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 671.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 585.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 606.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 702.25, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 671.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 435.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 476.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 650.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.72 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 364.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 958.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 541.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 435.17 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Conivaptan Hcl Iv Soln 20 Mg/100Ml In Dextrose 5%", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "66220016010", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "COLPOPEXY INTRAPERITONEAL", "code_information": [ { "code": "57283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18803.42, "discounted_cash": 7907.0, "minimum": 706.79, "maximum": 17483.6373, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9489.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10675.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11070.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12810.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12603.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9093.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8698.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11861.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.79 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17483.64, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12603.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 18803.4, "discounted_cash": 7907.0, "minimum": 706.79, "maximum": 17483.6373, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9489.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10675.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11070.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12810.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12256.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12603.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9093.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8698.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11861.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8302.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.79 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17483.64, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9884.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12603.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20105.0, "minimum": 9271.3464, "maximum": 53339.29, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24126.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18660.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 23452.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 23011.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23120.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 16883.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 25834.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 31868.33 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 25132.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 28148.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 32571.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25447.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 19041.65 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17949.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 31163.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50672.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49605.54 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 15714.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19549.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18660.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18660.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30158.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18305.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18660.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20105.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20105.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20105.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53339.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18305.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 4", "code_information": [ { "code": "6614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15236.72, "maximum": 15998.56, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15236.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15236.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15236.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15236.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15236.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15998.56, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15236.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 3", "code_information": [ { "code": "3463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8204.55, "maximum": 8614.78, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8614.78, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10074.0, "minimum": 6919.231, "maximum": 23831.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12089.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9378.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11483.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11267.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11321.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8485.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12649.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 15604.36 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12593.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14104.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16321.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12460.25 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9323.77 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9021.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15616.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22639.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22163.16 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7732.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9825.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9378.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9378.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15112.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9200.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9378.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10074.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10074.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11411.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8932.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10074.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23831.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9200.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9832.0, "minimum": 6744.8932, "maximum": 22924.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11798.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9154.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11194.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 10983.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11035.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8282.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12331.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 15211.19 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12290.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13765.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 15928.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12146.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9088.84 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15240.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21778.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21319.54 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7595.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9590.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9154.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9154.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14748.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8980.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9154.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9832.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9832.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11471.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9832.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22924.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8980.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7741", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2151.85, "maximum": 2259.44, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2151.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2151.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2151.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2151.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2151.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2259.44, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2151.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 3", "code_information": [ { "code": "3843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6727.86, "maximum": 7064.25, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6727.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6727.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6727.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6727.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6727.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7064.25, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6727.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16712.0, "minimum": 8683.9272, "maximum": 36670.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20055.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15521.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 19403.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 19038.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19129.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 14042.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 21374.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 26366.83 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20890.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23397.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 27074.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21054.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 15754.46 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14929.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25904.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34836.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34103.34 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 12947.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16260.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15521.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15521.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25069.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15225.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15521.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16712.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16712.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16207.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14782.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16712.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36670.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15225.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 3", "code_information": [ { "code": "0953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10000.11, "maximum": 10500.12, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10000.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10000.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10000.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10000.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10000.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10500.12, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10000.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1653", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36466.7, "maximum": 38290.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36466.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 36466.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 36466.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 36466.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 36466.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 38290.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36466.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 97037.0, "minimum": 56250.0, "maximum": 157201.1064, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 116445.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 89848.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 115249.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 113081.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 113620.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 81291.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 126955.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 156606.72 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 121297.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 135852.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 157201.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 125052.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 93574.13 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 86425.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 150408.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 77346.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 94127.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 89848.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 89848.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 145556.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 88137.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 89848.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 97037.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 97037.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 137442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 85570.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 97037.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 88137.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy W/Resection", "code_information": [ { "code": "45390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11608.0, "discounted_cash": 2959.0, "minimum": 320.11, "maximum": 11863.356, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3995.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4143.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4794.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3255.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.75 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4439.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.11 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1756.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6544.27, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3699.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49374.89, "maximum": 51843.63, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 49374.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 49374.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 49374.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 49374.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 49374.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 51843.63, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49374.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10209.0, "minimum": 7015.6596, "maximum": 19427.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12250.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9503.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11643.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11424.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11478.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8597.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12826.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 15821.83 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12761.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14292.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16538.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12633.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9453.71 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9141.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15824.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18456.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18067.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7611.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9955.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9503.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9503.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15313.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9322.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9503.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10209.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10209.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9050.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10209.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19427.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9322.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 2", "code_information": [ { "code": "6612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6191.56, "maximum": 6501.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6501.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9353.0, "minimum": 5964.2976, "maximum": 19723.43, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11224.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8711.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10622.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 10423.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10472.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7881.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11701.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 14434.93 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11692.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13095.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 15153.04, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11526.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8625.02 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8379.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14498.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18737.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18342.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7212.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9126.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8711.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8711.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14030.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8545.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8711.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9353.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9353.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9387.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8296.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9353.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19723.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8545.61, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 75327.0, "minimum": 48600.0, "maximum": 150939.3149, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 90393.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 69759.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 89344.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 87663.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 88081.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 63115.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 98419.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 121405.82 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 94159.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 105458.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 122030.84, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 96943.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 72541.23 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 67101.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 116757.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 60164.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 73081.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 69759.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 69759.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 112991.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 68430.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 69759.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 75327.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 75327.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67336.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 66437.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 75327.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 68430.73, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57520 - OR36057520", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8503.71, "discounted_cash": 3451.0, "minimum": 309.23, "maximum": 7632.2836, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6012.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.23 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6012.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7742", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2607.91, "maximum": 2738.31, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.31, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6565.0, "minimum": 4396.1224, "maximum": 22327.5922, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7878.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6131.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7296.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7158.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7192.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5547.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8037.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 9914.21 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8206.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9191.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10636.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7916.6 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5923.84 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5898.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10176.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12306.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12047.4 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4882.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6423.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6131.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6131.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9848.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6014.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6131.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6565.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6565.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6832.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6565.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12954.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6014.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52577.0, "minimum": 36291.7632, "maximum": 132467.5977, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 63093.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 48708.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 62198.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 61028.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 61319.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 44069.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 68515.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 84518.46 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 65721.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 73608.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 85175.58, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 67488.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 50500.65 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 46852.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 81495.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 122261.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 119688.02 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 41777.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 51027.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 48708.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 48708.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 78866.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 47780.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48708.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 52577.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52577.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68735.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46388.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 52577.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 128696.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 47780.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 1", "code_information": [ { "code": "3461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4037.21, "maximum": 4239.07, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4239.07, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12458.0, "minimum": 8632.5948, "maximum": 51283.3, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14949.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11584.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 14327.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14057.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14124.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10480.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 15782.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 19468.37 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15572.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17441.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 20182.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15545.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11632.55 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11142.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19310.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48719.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47693.47 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10015.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12135.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11584.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11584.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18687.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11363.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11584.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12458.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17798.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12458.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51283.3 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11363.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7762.0, "minimum": 5256.9552, "maximum": 14164.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9315.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7239.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8724.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8560.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8601.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6550.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9610.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11855.57 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9703.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10868.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12575.91, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9466.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7083.83 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6963.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12032.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12356.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12096.13 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6086.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7584.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7239.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11644.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7101.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7762.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7762.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14164.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6894.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7762.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13006.59 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7101.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Correct Malrotation Of Bowel", "code_information": [ { "code": "44055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48757.0, "minimum": 1659.52, "maximum": 40468.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3794.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3475.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3475.54 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1659.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1659.52 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3308.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3310.04 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 4", "code_information": [ { "code": "3464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17032.29, "maximum": 17883.9, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17032.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 17032.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17032.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 17032.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 17032.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17883.9, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17032.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0573", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7811.68, "maximum": 8202.26, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7811.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7811.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7811.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7811.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7811.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8202.26, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7811.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 1", "code_information": [ { "code": "0571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3559.12, "maximum": 3737.08, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3559.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3559.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3559.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3559.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3559.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3737.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3559.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28067.0, "minimum": 13500.0, "maximum": 74962.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 33681.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26028.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 32952.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 32333.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 32487.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 23549.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 36299.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 44778.11 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 35084.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 39294.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 45469.8, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 35755.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 26755.38 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25036.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 43505.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 71214.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69715.43 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 21716.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27267.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26028.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 26028.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42101.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 25532.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26028.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28067.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28067.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32282.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24788.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28067.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 74962.83 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25532.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7878.0, "minimum": 5298.02, "maximum": 24644.0767, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9454.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7346.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8862.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8695.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8737.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6646.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9762.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12042.79 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9847.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11029.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12762.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9616.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7195.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7066.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12211.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15063.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14746.39 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5298.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7696.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7346.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7346.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11817.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7206.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7346.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9184.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15856.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22494.0, "minimum": 9993.0576, "maximum": 73062.22, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26992.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20870.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 26302.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 25807.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25930.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 18883.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 28973.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 35740.97 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 28117.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 31491.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 36440.54, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28539.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 21355.6 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20075.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 34865.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69409.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 67947.86 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 17940.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21864.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20870.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20870.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33741.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20473.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20870.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22494.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 73062.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20473.31, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0574", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12911.1, "maximum": 13556.66, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12911.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12911.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12911.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12911.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12911.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13556.66, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12911.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 3", "code_information": [ { "code": "9103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26198.44, "maximum": 27508.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26198.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 26198.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26198.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 26198.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 26198.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27508.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26198.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Control Throat Bleeding - 42960 - OR36042960", "code_information": [ { "code": "42960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104.0, "discounted_cash": 575.0, "minimum": 162.45, "maximum": 10876.32, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 690.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 891.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 603.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 546.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 776.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 805.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 931.69, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 891.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 345.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 661.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 338.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 632.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 603.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 603.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 862.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 592.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 603.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.45 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1271.59, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 718.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 575.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 345.71 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 592.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Conz Of Cervix W/Scope Leep", "code_information": [ { "code": "57461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 3451.0, "minimum": 188.54, "maximum": 9210.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6012.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.54 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6012.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9954.67, "discounted_cash": 3451.0, "minimum": 260.44, "maximum": 8358.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8358.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.44 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8358.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 1", "code_information": [ { "code": "3841", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3684.25, "maximum": 3868.46, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3684.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3684.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3684.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3684.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3684.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3868.46, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3684.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Dstl Mtar Osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16937.5, "discounted_cash": 3489.0, "minimum": 522.6, "maximum": 14058.125, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8278.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 522.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 522.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8278.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 2", "code_information": [ { "code": "3462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5375.88, "maximum": 5644.67, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5375.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5375.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5375.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5375.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5375.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5644.67, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5375.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 1", "code_information": [ { "code": "0451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5205.01, "maximum": 5465.26, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5205.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5205.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5205.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5205.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5205.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5465.26, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5205.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 4", "code_information": [ { "code": "3844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11276.84, "maximum": 11840.68, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11276.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11276.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11276.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11276.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11276.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11840.68, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11276.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cor hlx vlgs jt arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11944.4, "discounted_cash": 13690.0, "minimum": 558.0, "maximum": 11944.42, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8278.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8278.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.47 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 } ] }, { "setting": "outpatient", "gross_charge": 11944.42, "discounted_cash": 13690.0, "minimum": 558.0, "maximum": 11944.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8278.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.47 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8278.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11944.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10695.0, "minimum": 7244.8368, "maximum": 30786.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12835.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9953.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12224.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11994.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12051.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9005.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13465.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16611.05 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13369.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14974.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17327.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13264.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9925.27 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9574.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16578.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29247.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28631.63 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8219.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10427.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9953.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9953.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16043.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9763.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9953.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10695.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10695.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14285.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10695.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30786.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9763.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 4", "code_information": [ { "code": "0454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12956.41, "maximum": 13604.23, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12956.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12956.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12956.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12956.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12956.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13604.23, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12956.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 68357.0, "minimum": 47328.8328, "maximum": 147847.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 82029.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 63309.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 81027.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 79503.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 79882.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 57280.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 89257.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 110104.72 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 85447.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 95700.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 110739.57, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 87919.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 65788.7 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 60898.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 105954.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 140454.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 137497.71 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 55496.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 66324.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 63309.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 63309.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 102536.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 62104.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 63309.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 68357.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68357.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 89195.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 60295.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 68357.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 147847.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 62104.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14442.0, "discounted_cash": 3489.0, "minimum": 488.0, "maximum": 11986.86, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8278.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 496.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 496.32 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8278.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Control Throat Bleeding - 42962 - OR36042962", "code_information": [ { "code": "42962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 3535.0, "minimum": 488.0, "maximum": 9090.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4242.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5480.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3358.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4772.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4949.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5727.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5480.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9090.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9090.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3889.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5303.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 506.37 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7816.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4419.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9090.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54300.0, "minimum": 34200.0, "maximum": 97575.6876, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 65160.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50302.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 64254.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 63045.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 63346.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 45511.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 70780.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 87312.41 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 67875.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 76020.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 87967.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 69719.9 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 52170.07 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48386.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 84166.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 43371.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 52697.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50302.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 50302.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 81451.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 49344.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50302.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 54300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77070.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47907.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 54300.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 49344.31, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37657.0, "minimum": 26100.0, "maximum": 104277.1785, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 45188.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34901.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 44395.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 43559.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 43767.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 31577.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 48904.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 60326.3 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 47071.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52719.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 61004.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 48171.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 36045.59 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33572.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 58368.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69756.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 68288.32 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 29195.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36563.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34901.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34901.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56485.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 34236.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34901.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37657.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37657.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55553.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33239.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37657.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 73428.3 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34236.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 2", "code_information": [ { "code": "3842", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4617.58, "maximum": 4848.46, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4617.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4617.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4617.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4617.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4617.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4848.46, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4617.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44507.03, "maximum": 46732.38, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 44507.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 44507.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 44507.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 44507.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 44507.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 46732.38, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 44507.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22928.26, "maximum": 24074.67, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22928.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 22928.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22928.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 22928.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 22928.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24074.67, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22928.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18121.5, "discounted_cash": 7737.0, "minimum": 615.58, "maximum": 17108.2537, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8278.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 5150.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 615.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 615.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17108.25, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8278.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Corrj Halux Rigdus W/Implt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17015.0, "discounted_cash": 7737.0, "minimum": 476.65, "maximum": 17015.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.65 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17015.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38888.0, "minimum": 20700.0, "maximum": 110382.5729, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 46665.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36040.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 45864.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 45001.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 45215.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 32608.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 50522.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 62322.39 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 48610.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 54443.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 62998.84, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 49765.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 37238.27 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 34667.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 60276.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 30241.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37756.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36040.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36040.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 58332.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 35354.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36040.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38888.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38888.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34324.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 38888.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35354.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7534.97, "discounted_cash": 7737.0, "minimum": 528.89, "maximum": 7534.97, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7534.97 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7534.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.89 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7534.97 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7534.97, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51349.0, "minimum": 32850.0, "maximum": 130742.55, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 61618.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47571.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 60732.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 59590.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 59874.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 43040.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 66901.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 82526.69 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 64186.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 71888.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 83185.54, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 65898.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 49310.55 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 45759.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 79591.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 124205.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 121590.57 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 40506.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 49836.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 32850.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 27000.0, "10th_percentile": 27000.0, "90th_percentile": 27000.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47571.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 47571.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 77023.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 46665.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47571.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 51349.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51349.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71942.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45306.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 51349.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 130742.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 46665.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1651", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24906.74, "maximum": 26152.08, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24906.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 24906.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24906.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 24906.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 24906.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 26152.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24906.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13287.75, "maximum": 13952.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13952.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22860.0, "minimum": 7200.0, "maximum": 49118.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27432.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21209.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 26739.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 26235.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26361.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 19189.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 29454.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 36334.33 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 28575.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32004.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 37033.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29013.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 21710.13 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20401.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 35433.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46662.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45680.11 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 17521.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 22219.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21209.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21209.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34290.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20805.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21209.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22860.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22860.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32228.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20199.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22860.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49118.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20805.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1652", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30329.6, "maximum": 31846.08, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30329.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 30329.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30329.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 30329.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 30329.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 31846.08, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30329.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cysto W/Ureter Stricture Tx", "code_information": [ { "code": "52341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988.0, "discounted_cash": 3758.0, "minimum": 280.55, "maximum": 6988.0, "payers_information": [ { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6988.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.55 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6988.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6988.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60238.0, "minimum": 24948.0, "maximum": 126420.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 72286.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55796.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 71339.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 69997.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 70331.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 50482.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 78585.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 96940.02 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 75298.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 84333.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 97586.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 77407.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 57922.66 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 53671.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 93369.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 120099.54 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 117571.13 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 48480.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 58453.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55796.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 55796.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 90357.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 54734.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55796.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 60238.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60238.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 113774.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53139.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 60238.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 126420.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 54734.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48972.0, "minimum": 34884.8022, "maximum": 110828.8787, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58766.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45371.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 57896.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 56807.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 57078.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 41050.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 63777.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 78672.77 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 61215.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68561.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79334.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 62821.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 47007.79 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43643.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75906.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91046.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 89129.33 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 37773.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47532.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45371.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45371.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73458.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 44507.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45371.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48972.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48972.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 73158.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48972.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 95837.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44507.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero Stricture Tx", "code_information": [ { "code": "52344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 3758.0, "minimum": 365.09, "maximum": 8310.9721, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.09 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8310.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 2", "code_information": [ { "code": "9102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23270.41, "maximum": 24433.93, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23270.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 23270.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23270.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 23270.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 23270.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24433.93, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23270.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25530.35, "maximum": 26806.87, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25530.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 25530.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25530.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 25530.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 25530.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 26806.87, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25530.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52224 - ", "code_information": [ { "code": "52224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8213.25, "discounted_cash": 3758.0, "minimum": 197.94, "maximum": 8213.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8213.25, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43968.24, "maximum": 46166.65, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43968.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 43968.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 43968.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 43968.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 43968.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 46166.65, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 43968.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30317.96, "maximum": 31833.86, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30317.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 30317.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30317.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 30317.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 30317.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 31833.86, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30317.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11796.3, "discounted_cash": 3758.0, "minimum": 242.72, "maximum": 9790.929, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.72 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8310.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 3", "code_information": [ { "code": "0453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8618.21, "maximum": 9049.12, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8618.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8618.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8618.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8618.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8618.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9049.12, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8618.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28439.0, "minimum": 10350.0, "maximum": 81109.1226, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 34126.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26371.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 33395.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 32767.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 32923.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 23860.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 36787.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 45380.1 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 35548.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 39814.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 46071.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36236.5 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 27115.08 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25367.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 44080.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 22685.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27627.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26371.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 26371.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42658.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 25869.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26371.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28439.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28439.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45314.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28439.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25869.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12676.7, "discounted_cash": 3758.0, "minimum": 285.44, "maximum": 10521.661, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.44 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8310.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cysto W/Urtrl Cathj", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8629.5, "discounted_cash": 2229.0, "minimum": 132.82, "maximum": 7162.485, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.82 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28966.0, "minimum": 12150.0, "maximum": 63254.9696, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 34760.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26860.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 34025.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 33385.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 33544.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 24301.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 37481.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 46235.57 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 36208.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 40553.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 46926.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36919.6 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 27626.23 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25836.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 44898.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 20320.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 28139.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26860.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 26860.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43450.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 26348.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26860.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28966.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28966.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25581.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28966.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 26348.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52281 - ", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10660.5, "discounted_cash": 2229.0, "minimum": 152.98, "maximum": 8848.215, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.98 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 10660.5, "discounted_cash": 2229.0, "minimum": 152.98, "maximum": 8848.215, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.98 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52276 - OR36052276", "code_information": [ { "code": "52276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11513.0, "discounted_cash": 2229.0, "minimum": 261.68, "maximum": 9555.79, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.68 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Corrj halux rigdus wo implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8806.91, "discounted_cash": 3489.0, "minimum": 477.73, "maximum": 7714.5107, "payers_information": [ { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 477.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 477.73 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5988.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5988.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52320 - OR36052320", "code_information": [ { "code": "52320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 3758.0, "minimum": 242.82, "maximum": 8310.9721, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.82 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8310.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8299.19, "discounted_cash": 3758.0, "minimum": 156.01, "maximum": 8299.19, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.01 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8299.19, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7089.96, "maximum": 7444.46, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7444.46, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14700.0, "minimum": 10245.0598, "maximum": 42418.18, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17641.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13659.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17003.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 16683.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16762.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12358.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 18730.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 23104.82 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18376.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20581.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 23815.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18449.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 13805.37 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13139.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22786.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40297.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39448.91 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10973.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14309.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13659.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13659.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22051.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13399.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13659.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14700.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14700.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13009.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14700.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42418.18 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13399.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY STONE REMOVAL", "code_information": [ { "code": "52325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 5717.0, "minimum": 316.99, "maximum": 4264.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4264.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3691.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3691.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.99 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3514.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 5717.0, "minimum": 316.99, "maximum": 4264.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4264.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3691.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3691.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.99 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3514.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4264.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy W/Biopsy(S)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7758.0, "discounted_cash": 2229.0, "minimum": 142.38, "maximum": 6439.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.38 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17248.47, "maximum": 18110.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17248.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 17248.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17248.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 17248.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 17248.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18110.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17248.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9606.0, "minimum": 6582.6888, "maximum": 15563.1294, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11528.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8945.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10924.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 10719.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10770.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8093.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12034.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 14845.39 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12008.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13449.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 15563.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11854.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8870.27 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8605.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14890.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14611.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14304.07 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7401.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9371.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8945.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8945.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14410.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8775.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8945.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9606.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9606.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10650.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9606.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15380.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8775.39, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURETERO WEXCISE TUMOR", "code_information": [ { "code": "52355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5551.0, "discounted_cash": 5717.0, "minimum": 461.15, "maximum": 5551.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5551.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5551.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2509.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5551.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5551.0, "discounted_cash": 5717.0, "minimum": 461.15, "maximum": 5551.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5551.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5551.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2509.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5551.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5551.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3942.9864, "maximum": 10800.0, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10168.31 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9954.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5607.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10703.48 } ] } ] }, { "description": "Cysto W/Irrg&Evac Mlt Clots", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7146.0, "discounted_cash": 3758.0, "minimum": 283.76, "maximum": 7146.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1904.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1864.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.76 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7146.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1904.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40836.0, "minimum": 29250.0, "maximum": 132413.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 49003.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37843.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 48188.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 47281.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 47507.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 34239.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 53082.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 65480.71 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 51045.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 57170.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 66154.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 52287.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 39125.4 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36401.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 63295.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 125792.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 123144.48 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 31753.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39645.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 29250.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 22500.0, "10th_percentile": 22500.0, "90th_percentile": 22500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37843.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37843.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 61254.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 37122.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37843.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 40836.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40836.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48560.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36041.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 40836.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 132413.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37122.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 3", "code_information": [ { "code": "1793", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31860.76, "maximum": 33453.8, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31860.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 31860.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31860.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 31860.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 31860.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33453.8, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31860.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16586.9, "discounted_cash": 5717.0, "minimum": 411.37, "maximum": 13767.127, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6861.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7718.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8004.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9262.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6575.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6289.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3691.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8576.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3691.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 411.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 411.37 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3514.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3515.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12641.72, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7147.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20342.38, "maximum": 21359.5, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20342.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 20342.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20342.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 20342.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 20342.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 21359.5, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20342.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYTOPATH CV INTERPRET", "code_information": [ { "code": "88141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.4, "minimum": 14.38, "maximum": 7078.572, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.79 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.62 } ] }, { "setting": "outpatient", "gross_charge": 8528.4, "minimum": 14.38, "maximum": 7078.572, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.62 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.79 } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 2", "code_information": [ { "code": "1142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3582.4, "maximum": 3761.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3582.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3582.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3582.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3582.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3582.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3761.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3582.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52214 - OR36052214", "code_information": [ { "code": "52214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13552.0, "discounted_cash": 3758.0, "minimum": 171.49, "maximum": 11248.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.49 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8310.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35197.0, "minimum": 17550.0, "maximum": 90378.18, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42237.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32625.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 41460.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 40680.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 40874.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 29518.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 45671.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 56338.44 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 43996.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57020.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 44986.85 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 33662.8 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 31382.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54556.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 85859.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 84051.71 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 26992.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 34179.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32625.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 32625.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52796.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 32004.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32625.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44307.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31072.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 90378.18 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 32004.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "D & C After Delivery", "code_information": [ { "code": "59160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.0, "discounted_cash": 3451.0, "minimum": 206.18, "maximum": 7083.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1468.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1468.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1468.76 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5204.01 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5094.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1468.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1542.2 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1542.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.18 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1468.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1468.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7083.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5204.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Destruction Vag Lesions Smpl", "code_information": [ { "code": "57061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11102.0, "discounted_cash": 3451.0, "minimum": 115.64, "maximum": 9214.66, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6012.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.64 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6012.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52260 - ", "code_information": [ { "code": "52260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.4, "discounted_cash": 2229.0, "minimum": 208.87, "maximum": 7078.572, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.87 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 8528.4, "discounted_cash": 2229.0, "minimum": 208.87, "maximum": 7078.572, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.87 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Create Eardrum Opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6064.0, "discounted_cash": 1654.0, "minimum": 157.54, "maximum": 5033.12, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1985.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2233.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2316.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2680.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2564.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4816.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1902.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4714.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1820.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2481.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1273.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1737.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.54 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1212.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1212.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3658.21, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2068.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4816.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dantrolene Sodium For Iv Soln 20 Mg", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "42023012306", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy Chemodenervation", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 2229.0, "minimum": 168.45, "maximum": 7544.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.45 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448.0, "discounted_cash": 743.0, "minimum": 80.22, "maximum": 4550.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 892.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1152.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 780.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 706.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1003.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1041.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1204.58, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1152.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1904.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 855.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1864.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 817.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 780.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1115.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 765.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.22 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1644.03, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 929.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1904.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 765.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 2", "code_information": [ { "code": "0452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6438.5, "maximum": 6760.43, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6438.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6438.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6438.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6438.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6438.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6760.43, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6438.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.0, "discounted_cash": 788.0, "minimum": 157.24, "maximum": 7078.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 945.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1063.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1103.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1276.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 784.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 767.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 866.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.24 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 330.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1742.53, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 784.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Skin Abdominal Wall", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10093.5, "minimum": 845.78, "maximum": 8377.605, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 845.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 845.78 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 880.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 } ] } ] }, { "description": "Dexmedetomidine Hcl Iv Soln 200 Mcg/2Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "55150020902", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9975.59, "maximum": 10474.37, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9975.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9975.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9975.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9975.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9975.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10474.37, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9975.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dcmprn Px Perq 1/Mlt Lumbar", "code_information": [ { "code": "62287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17827.0, "discounted_cash": 2082.0, "minimum": 577.09, "maximum": 14796.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2498.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2811.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2915.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3373.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9719.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2394.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9515.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2290.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3123.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 577.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 577.09 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4277.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4604.01, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2602.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9719.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 10% Amino Acids 3% Calcium Gluconate 300 Mg/100 Ml Heparin 0.5 Units/Ml 250 Ml (Neonate) - Premix", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "99999109315", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy And Treatment - 52240 - OR36052240", "code_information": [ { "code": "52240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.2, "discounted_cash": 5717.0, "minimum": 387.51, "maximum": 10744.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6861.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7718.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8004.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9262.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6575.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6289.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8576.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 387.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 387.51 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10744.2, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7147.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 2", "code_information": [ { "code": "1792", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25958.97, "maximum": 27256.92, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27256.92, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25958.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25958.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 25958.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25958.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 25958.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 25958.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8982.0, "discounted_cash": 2229.0, "minimum": 150.97, "maximum": 7455.06, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1904.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1864.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.97 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1904.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 3", "code_information": [ { "code": "0423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7507.36, "maximum": 7882.73, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7507.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7507.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7507.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7507.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7507.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7882.73, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7507.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52330 - OR36052330", "code_information": [ { "code": "52330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988.0, "discounted_cash": 3758.0, "minimum": 259.33, "maximum": 6988.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6988.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.33 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6988.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6988.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11958.0, "minimum": 8273.7016, "maximum": 19373.418, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14350.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11122.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 13731.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 13473.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13537.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10062.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 15126.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 18658.99 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14948.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16742.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19373.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14899.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11148.94 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10698.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18536.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17963.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17584.93 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9474.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11651.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11122.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17938.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10910.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11122.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11958.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11958.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10592.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11958.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18908.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10910.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 10%", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338002302", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Cystouretero & Or Pyeloscope", "code_information": [ { "code": "52351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9431.0, "discounted_cash": 3758.0, "minimum": 298.84, "maximum": 8310.9721, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5636.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.84 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8310.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5636.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 3", "code_information": [ { "code": "4203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5501.85, "maximum": 5776.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5501.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5501.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5501.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5501.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5501.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5776.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5501.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystouretero W/Biopsy", "code_information": [ { "code": "52354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111.0, "discounted_cash": 5717.0, "minimum": 412.71, "maximum": 12641.7242, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6861.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7718.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8004.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9262.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6575.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6289.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8576.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.71 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2509.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12641.72, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7147.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6744.0, "minimum": 4524.481, "maximum": 24430.9346, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8092.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6296.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7509.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7367.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7402.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5697.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8271.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10203.68 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8430.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9441.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10925.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8147.75 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6096.81 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6056.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10453.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10890.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10661.25 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4683.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6596.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6296.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6296.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10116.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6176.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6296.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6744.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6744.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6624.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5996.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6744.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11463.71 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6176.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8411.0, "minimum": 5382.0768, "maximum": 16700.96, "payers_information": [ { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7839.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7839.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12616.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7690.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7839.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8411.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7198.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8411.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16700.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7690.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10093.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7839.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9498.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9319.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9364.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7092.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10463.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12906.9 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10514.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11775.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13626.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10306.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7712.01 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7540.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13037.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15531.89 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6512.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8212.82, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16852.3, "discounted_cash": 5717.0, "minimum": 385.97, "maximum": 13987.409, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6861.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7718.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8004.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9262.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8862.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10239.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6575.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10024.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6289.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8576.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2636.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6003.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.97 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2509.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2510.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12641.72, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7147.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10239.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 3", "code_information": [ { "code": "1143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5753.37, "maximum": 6041.04, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6041.04, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5968.0, "minimum": 3966.9832, "maximum": 17046.2628, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7162.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5579.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 6583.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6459.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6490.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5047.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7252.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 8946.4 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7460.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8356.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9669.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7143.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5345.57 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5366.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9251.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10617.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10393.55 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4448.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5844.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5579.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5579.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8953.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5472.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5579.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5968.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5968.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5212.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5313.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5968.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11175.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5472.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Stone Remove", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7932.5, "discounted_cash": 3758.0, "minimum": 350.25, "maximum": 7932.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6998.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.25 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7932.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6998.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER - SOI : 2", "code_information": [ { "code": "7542", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2883.54, "maximum": 3027.72, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2883.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2883.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2883.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2883.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2883.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3027.72, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2883.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18651.0, "minimum": 9855.3, "maximum": 30215.7378, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22382.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17315.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 21717.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 21308.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21410.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15666.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 23923.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 29510.75 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23314.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26112.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 30215.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23564.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 17632.98 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28910.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21907.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21445.93 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13873.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18139.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17315.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17315.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27977.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16985.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17315.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18651.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18651.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17326.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16490.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18651.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23060.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16985.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8808.0, "minimum": 4848.0, "maximum": 18000.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10570.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8206.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9972.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9784.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9831.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7425.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10985.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13550.66 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11010.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12331.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14269.54, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10820.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8096.66 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7894.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13652.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8517.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6490.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8597.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8206.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8206.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13212.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8050.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8206.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8808.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8808.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5214.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7816.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8808.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8965.39 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8050.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 2", "code_information": [ { "code": "2402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5518.06, "maximum": 5793.96, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5518.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5518.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5518.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5518.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5518.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5793.96, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5518.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5492.976, "maximum": 24696.69, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23461.86 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22967.92 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8718.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15493.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24696.69 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10554.0, "minimum": 4944.27, "maximum": 22170.6073, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12665.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9822.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12055.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11829.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11885.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8887.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 13280.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 16382.06 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13193.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14776.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 17098.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13081.25 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9788.45 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9448.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16359.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17301.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16937.41 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7276.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10290.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9822.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15831.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9635.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10554.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10554.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4944.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9355.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10554.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18212.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 3", "code_information": [ { "code": "2403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7524.82, "maximum": 7901.06, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7901.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Destruction anal lesion(s) - 46910 - ", "code_information": [ { "code": "46910", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3837.66, "discounted_cash": 2200.0, "minimum": 143.63, "maximum": 3837.66, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2640.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3410.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2970.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3080.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3564.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 3837.66 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3410.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3837.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2530.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 3837.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2420.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3300.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.63 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1246.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3837.66, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2750.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 3837.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 1", "code_information": [ { "code": "1791", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22906.64, "maximum": 24051.97, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22906.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 22906.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22906.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 22906.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 22906.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24051.97, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22906.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Destruction Vag Lesion Xtnsv", "code_information": [ { "code": "57065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 3451.0, "minimum": 186.39, "maximum": 7632.2836, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6012.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.39 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6012.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 4", "code_information": [ { "code": "1794", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43695.52, "maximum": 45880.3, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43695.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 43695.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 43695.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 43695.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 43695.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 45880.3, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 43695.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 1", "code_information": [ { "code": "5171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4479.97, "maximum": 4703.97, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.97, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dbrdmt Bone 1St 20 Sq Cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 1761.0, "minimum": 229.92, "maximum": 7544.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2018.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1975.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.92 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 880.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2018.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 3", "code_information": [ { "code": "5173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9544.88, "maximum": 10022.12, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9544.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9544.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9544.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9544.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9544.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10022.12, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9544.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 1", "code_information": [ { "code": "0421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4395.99, "maximum": 4615.79, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4615.79, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dbrdmt Opn Wnd 1St 20 Cm/<", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 213.0, "minimum": 33.42, "maximum": 7544.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 256.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 331.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 203.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 288.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 299.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 346.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 331.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 235.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.95 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.42 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 157.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 473.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 267.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Diag Laparo Separate Proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16002.0, "discounted_cash": 6446.0, "minimum": 371.22, "maximum": 14253.7643, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7736.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 9992.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6124.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8703.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9025.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10443.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9992.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9418.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7413.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9220.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7091.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9670.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6640.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6769.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 371.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 371.22 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3168.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14253.76, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8058.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9418.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6640.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 4", "code_information": [ { "code": "5174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16789.5, "maximum": 17628.98, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16789.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 16789.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16789.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 16789.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 16789.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17628.98, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16789.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 4", "code_information": [ { "code": "0424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13367.16, "maximum": 14035.52, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13367.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 13367.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13367.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 13367.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 13367.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14035.52, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13367.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9216.75, "discounted_cash": 433.0, "minimum": 61.73, "maximum": 7649.9025, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 784.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 520.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 671.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 585.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 606.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 702.25, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 671.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 784.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.51, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 767.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 476.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 650.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.73 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 330.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 958.45, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 541.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11195.0, "minimum": 7724.5056, "maximum": 27695.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13434.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10415.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 12819.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 12578.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12638.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9423.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 14122.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 17420.43 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13993.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15673.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 18135.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13910.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10408.89 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10018.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17352.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26310.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25756.44 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8723.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10911.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10415.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10415.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16792.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10216.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10415.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11195.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11195.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13043.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11195.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27695.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10216.97, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dilation And Curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9678.36, "discounted_cash": 3451.0, "minimum": 239.05, "maximum": 8033.0388, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 2169.11, "10th_percentile": 2169.11, "90th_percentile": 2169.11, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5204.01 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5094.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2116.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.05 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2014.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2015.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5204.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21085.0, "minimum": 14835.3166, "maximum": 51234.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 25302.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19567.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 24621.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 24158.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 24273.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 17703.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 27122.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 33456.84 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 26356.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 29519.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 34158.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26715.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 19990.81 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18821.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 32682.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48672.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47648.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 17779.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20499.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19567.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19567.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31628.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19194.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19567.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21085.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21085.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18635.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 21085.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51234.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19194.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13904.75, "discounted_cash": 3097.0, "minimum": 421.53, "maximum": 11540.9425, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1199.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.53 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 880.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13904.8, "discounted_cash": 3097.0, "minimum": 421.53, "maximum": 11540.9425, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1199.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 924.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.53 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 880.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 880.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8532.0, "minimum": 5809.9828, "maximum": 32213.812, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10238.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7951.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9642.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9461.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9506.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7194.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10621.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13102.77 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10665.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11944.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 13822.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10462.7 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7829.04 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7648.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13224.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13428.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13145.89 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6678.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8329.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7951.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7951.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12798.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7799.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7951.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8532.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8532.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9328.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8532.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14135.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7799.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Debride skin at fx site", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13870.34, "discounted_cash": 755.0, "minimum": 283.34, "maximum": 11512.3822, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 717.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1019.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1057.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1223.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1199.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 830.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.6 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.34 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 330.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 943.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13870.3, "discounted_cash": 755.0, "minimum": 283.34, "maximum": 11512.3822, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 717.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1019.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1057.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1223.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1199.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 830.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.6 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.34 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 330.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 943.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15700.0, "minimum": 10963.4848, "maximum": 57201.2134, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18840.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14584.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 18195.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 17853.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17938.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 13195.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 20043.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 24725.03 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19625.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21980.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 25434.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19743.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14773.46 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14028.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24335.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28860.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28253.25 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11626.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15278.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14584.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14584.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23550.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14306.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14584.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15700.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15700.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18371.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13889.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15700.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30379.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14306.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Decompression Of Leg", "code_information": [ { "code": "27892", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12100.5, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 10043.415, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3604.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3604.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3604.98 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6118.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3604.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3785.23 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3785.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 591.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 591.39 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3603.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3604.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7714.51, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6118.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 1", "code_information": [ { "code": "7521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1943.15, "maximum": 2040.31, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 1943.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 1943.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 1943.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 1943.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 1943.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.31, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1943.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER - SOI : 1", "code_information": [ { "code": "7541", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2155.18, "maximum": 2262.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2262.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Decompression Of Tibia Nerve", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111.0, "discounted_cash": 2082.0, "minimum": 374.19, "maximum": 12542.13, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2498.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2385.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2811.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2915.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3373.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 690.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5233.31 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2394.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5123.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2290.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4898.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3123.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2711.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4604.01, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2602.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5233.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 4", "code_information": [ { "code": "7524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24845.63, "maximum": 26087.91, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24845.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 24845.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24845.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 24845.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 24845.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 26087.91, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24845.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER - SOI : 4", "code_information": [ { "code": "7544", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9674.18, "maximum": 10157.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9674.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9674.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9674.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9674.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9674.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10157.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9674.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10171.0, "minimum": 6988.8384, "maximum": 21789.19, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12206.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9468.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 11599.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 11380.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11435.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8566.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 12777.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 15761.34 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12714.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14240.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 16478.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12585.6 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 9417.56 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9107.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15766.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20699.73 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20263.95 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7699.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9919.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9468.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9468.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15257.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9288.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9468.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10171.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10171.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9985.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10171.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21789.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9288.17, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 1", "code_information": [ { "code": "2841", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4254.64, "maximum": 4467.37, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4467.37, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Destruction anal lesion(s) - 46924 - ", "code_information": [ { "code": "46924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1849.37, "discounted_cash": 2959.0, "minimum": 191.59, "maximum": 1849.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 1849.37 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1849.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1849.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.59 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1246.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1849.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 2", "code_information": [ { "code": "0422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5579.59, "maximum": 5858.57, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5579.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5579.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5579.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5579.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5579.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5579.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 1", "code_information": [ { "code": "2441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3486.78, "maximum": 3661.12, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3486.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3486.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3486.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3486.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3486.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3661.12, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3486.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 4", "code_information": [ { "code": "2844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13507.26, "maximum": 14182.62, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13507.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 13507.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13507.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 13507.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 13507.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14182.62, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13507.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 3", "code_information": [ { "code": "2823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6967.74, "maximum": 7316.13, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7316.13, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 1", "code_information": [ { "code": "1141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2595.44, "maximum": 2725.21, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2595.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2595.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2595.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2595.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2595.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2725.21, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2595.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14930.0, "minimum": 10410.4572, "maximum": 54765.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17917.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13872.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17277.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 16952.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17033.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12551.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19032.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 23477.83 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18663.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20903.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24188.07, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18747.3 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14028.25 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13343.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23142.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52027.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50931.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11812.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14532.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13872.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13872.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22396.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13608.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13872.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14930.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14930.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18556.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14930.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54765.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13608.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 4", "code_information": [ { "code": "1144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10069.96, "maximum": 10573.46, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10069.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10069.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10069.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10069.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10069.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10573.46, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10069.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 2", "code_information": [ { "code": "7522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2738.04, "maximum": 2874.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2874.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dextrose 5% Amino Acids 3% Calcium Gluconate 300 Mg/100 Ml Heparin 0.5 Units/Ml 250 Ml (Neonate)- Premix", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "99999409316", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER - SOI : 3", "code_information": [ { "code": "7543", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4574.34, "maximum": 4803.06, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4803.06, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15292.0, "minimum": 10670.3674, "maximum": 32512.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18350.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14206.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17709.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 17375.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17458.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12853.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19507.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 24063.98 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19115.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21409.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24773.7, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19215.35 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14378.48 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13665.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23703.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30886.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30236.55 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11959.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14883.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14206.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14206.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22938.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13936.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14206.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15292.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15292.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15220.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13530.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15292.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32512.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13936.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Destroy Vulva Lesion/S Compl", "code_information": [ { "code": "56515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104.0, "discounted_cash": 2200.0, "minimum": 213.18, "maximum": 10876.32, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2640.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3410.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2970.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3080.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3564.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3410.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5989.08 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2530.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5862.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2420.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3300.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.18 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4864.66, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2750.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5989.08 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 1", "code_information": [ { "code": "3041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18777.96, "maximum": 19716.86, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18777.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 18777.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18777.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 18777.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 18777.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19716.86, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18777.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 3", "code_information": [ { "code": "2443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6887.5, "maximum": 7231.88, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6887.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6887.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6887.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6887.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6887.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7231.88, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6887.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dextrose Inj 70%", "drug_information": { "unit": 2000.0, "type": "ML" }, "code_information": [ { "code": "00338071906", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Drain Open Retroperi Abscess", "code_information": [ { "code": "49060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "minimum": 1215.1, "maximum": 7544.7, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.1 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3168.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22307.56, "maximum": 23422.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22307.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 22307.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22307.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 22307.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 22307.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 23422.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22307.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES - SOI : 1", "code_information": [ { "code": "4201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2895.6, "maximum": 3040.38, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2895.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2895.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2895.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2895.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2895.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3040.38, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2895.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Drain/Inj Joint/Bursa W/O Us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.0, "discounted_cash": 327.0, "minimum": 45.6, "maximum": 5679.69, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 530.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 662.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 376.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 649.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 723.7, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 662.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60660.46, "maximum": 63693.48, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 60660.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 60660.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 60660.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 60660.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 60660.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 63693.48, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 60660.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13212.0, "minimum": 7764.6768, "maximum": 30790.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15854.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12281.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 15226.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 14940.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15011.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 11112.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 16773.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 20691.08 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16515.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18497.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 21403.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16522.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 12363.13 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11814.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20478.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29250.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28635.04 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 10339.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12866.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18000.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12281.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12281.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19818.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12048.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12281.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13212.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13212.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13212.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30790.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12048.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Gland Abscess", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.0, "discounted_cash": 215.0, "minimum": 101.016, "maximum": 7078.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 258.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 334.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 226.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 204.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 291.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 301.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 334.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.21 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 378.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 370.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 237.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 226.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.37 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 222.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.14 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 183.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.67, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 378.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Rectal Abscess", "code_information": [ { "code": "45005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9728.0, "discounted_cash": 1276.0, "minimum": 196.66, "maximum": 8074.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1531.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1212.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1722.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1786.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2067.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1977.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3734.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1467.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 3656.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1403.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1914.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1339.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.66 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1246.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1247.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2821.37, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1595.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 3734.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Drain Bl W/Cath Insertion", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11342.5, "discounted_cash": 2229.0, "minimum": 140.95, "maximum": 9414.275, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3009.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3120.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3611.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3455.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2563.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3343.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2340.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.95 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1349.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1350.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4928.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 2", "code_information": [ { "code": "4202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3721.25, "maximum": 3907.31, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3721.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3721.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3721.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3721.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3721.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3907.31, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3721.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 2", "code_information": [ { "code": "7702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2576.32, "maximum": 2705.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2576.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 2576.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2576.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 2576.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 2576.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2705.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2576.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Drain Thigh/Knee Lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 3097.0, "minimum": 549.89, "maximum": 7544.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5133.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5025.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 549.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 549.89 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5133.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 1", "code_information": [ { "code": "2401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4774.31, "maximum": 5013.03, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4774.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4774.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4774.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4774.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4774.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5013.03, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4774.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES - SOI : 4", "code_information": [ { "code": "4204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10758.42, "maximum": 11296.34, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10758.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10758.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10758.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10758.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10758.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11296.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10758.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11744.0, "minimum": 8119.799, "maximum": 24927.49, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14093.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10924.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 13476.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 13222.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13285.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9883.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 14844.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 18311.9 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14681.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16442.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19026.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14622.25 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10941.55 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10507.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18204.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23681.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23182.57 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 8838.08, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11444.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10924.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10924.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17617.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10716.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10924.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11744.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11744.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13824.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11744.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24927.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10716.02, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 3", "code_information": [ { "code": "7703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4081.28, "maximum": 4285.34, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4285.34, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19258.0, "minimum": 6511.8624, "maximum": 39486.62, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23110.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17876.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 22441.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 22019.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22124.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 16174.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24720.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 30494.39 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24072.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26961.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 31198.53, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24350.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 18220.71 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17195.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29850.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37512.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36722.56 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 16288.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18727.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17876.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17876.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28887.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17536.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17876.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19258.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19258.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16201.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17025.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19258.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39486.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17536.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 2", "code_information": [ { "code": "5172", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5686.85, "maximum": 5971.19, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5686.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5686.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5686.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5686.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5686.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5971.19, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5686.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 4", "code_information": [ { "code": "2404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12369.39, "maximum": 12987.86, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12369.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12369.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12369.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12369.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12369.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12987.86, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12369.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 1", "code_information": [ { "code": "1101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4698.23, "maximum": 4933.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4698.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4698.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4698.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4698.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4698.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4933.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4698.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dx Bronchoscope/Lavage", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3089.0, "discounted_cash": 1898.0, "minimum": 132.03, "maximum": 7459.9155, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2562.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2657.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3074.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 3089.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 565.91, "10th_percentile": 565.91, "90th_percentile": 565.91, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2791.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2847.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.03 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3089.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2791.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl 125 Mg/125Ml In Dextrose 5% Iv Soln (1 Mg/Ml)", "drug_information": { "unit": 125.0, "type": "ML" }, "code_information": [ { "code": "63037011905", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19447.0, "minimum": 13657.7382, "maximum": 50004.69, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23337.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18051.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 22667.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 22240.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22346.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 16332.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 24969.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 30801.15 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24309.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27226.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 31505.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24595.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 18404.01 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17364.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30143.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47504.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46504.36 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 14990.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18911.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18051.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18051.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29171.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17707.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18051.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19447.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19447.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24696.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17192.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19447.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50004.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17707.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 4", "code_information": [ { "code": "1104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12676.62, "maximum": 13310.45, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12676.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 12676.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12676.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 12676.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 12676.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13310.45, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12676.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dx Bronchoscope/Wash", "code_information": [ { "code": "31622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8660.5, "discounted_cash": 1898.0, "minimum": 133.94, "maximum": 7459.9155, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2562.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2657.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3074.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2791.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1442.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2847.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4196.52, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2791.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl Iv Soln 50 Mg/10Ml (5 Mg/Ml)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00641601310", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8660.0, "minimum": 5902.5798, "maximum": 19916.05, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10393.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8070.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 9796.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 9611.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9657.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7301.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 10791.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13311.59 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10826.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12125.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14030.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10629.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7953.81 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7763.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13424.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18920.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18521.93 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6269.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8454.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8070.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8070.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12991.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7916.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8070.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8660.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8660.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10096.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8660.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19916.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7916.73, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 2", "code_information": [ { "code": "7592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6203.2, "maximum": 6513.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6203.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6203.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6203.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6203.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6203.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6513.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6203.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dx Laryngoscopy Excl Nb", "code_information": [ { "code": "31525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39195.0, "discounted_cash": 1898.0, "minimum": 154.84, "maximum": 32531.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2562.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2657.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3074.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4337.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4245.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1442.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.73 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2847.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.84 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 523.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4196.52, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4337.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 3", "code_information": [ { "code": "2843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7782.58, "maximum": 8171.71, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7782.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7782.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7782.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7782.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7782.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7782.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Egd Esophagogastrc Fndoplsty", "code_information": [ { "code": "43210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27062.0, "discounted_cash": 11335.0, "minimum": 429.23, "maximum": 25062.3483, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13602.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 17569.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11902.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 10768.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 15302.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15869.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18363.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17569.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13035.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12468.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11902.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3416.89 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11902.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17002.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3416.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 11675.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11902.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.23 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3252.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25062.35, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14169.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11335.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11675.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 3", "code_information": [ { "code": "1103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7784.66, "maximum": 8173.89, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7784.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 7784.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7784.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 7784.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 7784.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8173.89, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7784.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16392.0, "minimum": 11460.9542, "maximum": 45983.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19670.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15224.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 19021.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 18663.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 18752.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 13774.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 20953.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 25846.93 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20490.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22948.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 26555.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20639.05 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 15443.81 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14644.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25407.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43684.08 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42764.41 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13421.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15949.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15224.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15224.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24588.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14934.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15224.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16392.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16392.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20555.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14499.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16392.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45983.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14934.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 2", "code_information": [ { "code": "2842", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5619.09, "maximum": 5900.04, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5619.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5619.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5619.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5619.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5619.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5900.04, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5619.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Elbow arthroscopysurgery", "code_information": [ { "code": "29838", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 5548.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5548.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5548.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.12 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5548.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5548.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 5548.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5548.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5548.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3348.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1947.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.12 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1853.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1854.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5548.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5548.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 1", "code_information": [ { "code": "7591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3964.04, "maximum": 4162.24, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4162.24, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6665.0, "minimum": 4468.2842, "maximum": 15185.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7999.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6224.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7415.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7276.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7310.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5631.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8169.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10076.95 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8332.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9332.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 10798.84, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8046.55 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6021.08 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5987.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10332.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14426.39 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.67 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4989.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6520.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6224.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6224.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9998.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6105.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6224.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6665.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6665.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6826.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6665.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15185.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6105.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9025.0, "minimum": 6164.4058, "maximum": 22018.55, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10830.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8407.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10230.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 10038.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10086.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 7606.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11269.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 13902.07 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11281.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12635.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 14620.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11100.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8306.63 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8087.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13988.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20917.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20477.25 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6860.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8807.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8407.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8407.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13537.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8247.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8407.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9025.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9025.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10600.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8007.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9025.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22018.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8247.3, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23369.35, "maximum": 24537.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23369.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 23369.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23369.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 23369.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 23369.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24537.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23369.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 188978.0, "minimum": 108450.0, "maximum": 404587.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 226774.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 174924.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 224955.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 220723.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 221776.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 158265.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 247804.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 305681.3 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 236223.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 264570.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 306145.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 244089.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 182647.73 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 168260.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 292917.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 384358.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 376266.28 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 152164.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 183254.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 174924.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 174924.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 283468.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 171592.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 174924.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 188978.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 188978.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 293865.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 166595.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 188978.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 404587.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 171592.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 1", "code_information": [ { "code": "2821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3515.46, "maximum": 3691.23, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3515.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 3515.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3515.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 3515.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 3515.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3691.23, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3515.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 2", "code_information": [ { "code": "2822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4577.25, "maximum": 4806.11, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4806.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19698.4, "maximum": 20683.32, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19698.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 19698.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19698.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 19698.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 19698.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20683.32, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19698.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7922.0, "minimum": 5371.9032, "maximum": 25653.97, "payers_information": [ { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7387.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7922.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7922.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8662.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7922.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25653.97 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9507.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7387.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8915.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8747.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8789.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6683.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9821.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 12114.8 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9903.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11091.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12834.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9673.8 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7238.72 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7106.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12280.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24371.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23858.19 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 6107.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7739.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7035.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7387.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7387.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7246.74, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 4", "code_information": [ { "code": "2824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15429.63, "maximum": 16201.11, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15429.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15429.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15429.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15429.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15429.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16201.11, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15429.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10014.66, "maximum": 10515.39, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10014.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10014.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10014.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10014.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10014.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10515.39, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10014.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 3", "code_information": [ { "code": "7523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6275.53, "maximum": 6589.31, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6275.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 6275.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6275.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 6275.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 6275.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6589.31, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6275.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5970.0, "minimum": 3968.2604, "maximum": 15715.96, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 7164.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5580.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 6585.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 6462.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6492.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5049.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 7254.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 8949.28 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7463.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8358.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 9672.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7146.1 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 5347.29 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5368.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 9254.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14615.84 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 4367.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5846.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5580.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8955.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5474.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5970.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5970.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6510.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5315.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5970.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15715.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5474.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15072.0, "minimum": 8880.6, "maximum": 54541.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18086.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14003.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 17446.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 17118.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17199.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 12669.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 19218.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 23706.82 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18840.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21100.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 24416.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18930.15 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 14165.07 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23361.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51814.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50723.92 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 11766.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14669.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14003.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14003.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22608.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13736.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14003.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15072.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15072.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16851.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15072.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54541.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13736.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15031.35, "maximum": 15782.92, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15031.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 15031.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15031.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 15031.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 15031.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15782.92, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15031.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7799.0, "minimum": 5283.1378, "maximum": 15229.27, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9359.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7273.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8768.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8603.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8644.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6580.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9658.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11914.62 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9749.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10919.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12634.91, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9513.95 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 7119.11 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12088.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14467.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14163.22 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5660.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7619.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9900.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7273.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11699.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7134.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7613.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15229.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7134.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17916.0, "minimum": 7029.6, "maximum": 29024.3088, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21499.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16634.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 20839.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 20447.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20545.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 15050.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 22956.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 28318.28 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22395.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25082.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 29024.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22612.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 16920.46 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27770.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12331.38 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12071.77 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 13162.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17426.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16634.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16634.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26874.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16317.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16634.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17916.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17916.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13933.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17916.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12980.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16317.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 2", "code_information": [ { "code": "2442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4555.22, "maximum": 4782.98, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4555.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 4555.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4555.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 4555.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 4555.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4782.98, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4555.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Enalaprilat Iv Soln 1.25 Mg/Ml", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143978610", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 4", "code_information": [ { "code": "2444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11790.27, "maximum": 12379.78, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11790.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 11790.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11790.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 11790.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 11790.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12379.78, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11790.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9555.0, "minimum": 6545.65, "maximum": 19454.97, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11466.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8898.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 10863.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 10659.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10709.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 8050.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 11966.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 14761.86 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11944.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13377.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 15479.68, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11787.5 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 8820.36 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8559.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14810.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18482.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18093.12 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 7337.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9321.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8898.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8898.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14333.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8728.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8898.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9555.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9555.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9330.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9555.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19454.97 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8728.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Epinephrine Soln Prefilled Syringe 1 Mg/10Ml (0.1 Mg/Ml)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409493311", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.39, "10th_percentile": 6.39, "90th_percentile": 6.39, "count": "1 through 10" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7275.0, "minimum": 4906.3638, "maximum": 60003.9682, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8730.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6788.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8142.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7989.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8027.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6141.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8969.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11064.91 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9094.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10185.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11785.95, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8835.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6611.4 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6529.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11276.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10419.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10200.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5528.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7111.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6788.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6788.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10912.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6658.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6788.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7275.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5853.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6465.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7275.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10968.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6658.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12277.0, "minimum": 6395.7648, "maximum": 19889.9874, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14733.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11417.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 14111.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 13846.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13912.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 10329.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 15545.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 19176.01 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15347.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17188.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 19889.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15312.25 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 11457.86 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10982.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19030.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9813.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11960.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11417.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11417.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18416.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11199.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11417.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12277.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12277.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17437.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12277.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11199.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46559.94, "maximum": 48887.94, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 46559.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 46559.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 46559.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 46559.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 46559.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 48887.94, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46559.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Epidural Lysis On Single Day", "code_information": [ { "code": "62264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2670.87, "discounted_cash": 943.0, "minimum": 233.55, "maximum": 2670.87, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1131.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1461.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 990.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 896.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1273.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1320.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1527.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 2670.87 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1461.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2670.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1084.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2670.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1037.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 990.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.6 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1414.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 971.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 990.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 233.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 233.55 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 662.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2085.35, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1178.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 943.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2670.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 971.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 3", "code_information": [ { "code": "3033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45930.1, "maximum": 48226.61, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 45930.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 45930.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 45930.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 45930.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 45930.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 48226.61, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 45930.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 3", "code_information": [ { "code": "3043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31465.39, "maximum": 33038.66, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31465.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 31465.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31465.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 31465.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 31465.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33038.66, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31465.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Eravacycline Dihydrochloride Iv For Soln 50 Mg (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "71773005012", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Epinephrine Hcl Inj 1 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "54288010310", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.39, "10th_percentile": 6.39, "90th_percentile": 6.39, "count": "1 through 10" } ] } ] }, { "description": "DRAININJECT JOINTBURSA", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7699.25, "discounted_cash": 327.0, "minimum": 35.04, "maximum": 6390.3775, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 530.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 662.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 376.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 649.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.04 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 723.7, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 662.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 1", "code_information": [ { "code": "3031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27783.22, "maximum": 29172.38, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27783.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 27783.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 27783.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 27783.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 27783.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 29172.38, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27783.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11716.0, "minimum": 8099.3638, "maximum": 22384.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14059.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10897.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 13442.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 13189.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13252.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 9859.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 14807.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 18265.82 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14645.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16402.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 18980.58, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14585.45 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 10914.01 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10482.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18160.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21265.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20817.55 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 9119.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11416.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10897.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10897.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17574.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10690.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10897.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11716.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11716.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11771.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10378.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11716.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22384.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10690.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33370.3, "maximum": 35038.82, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33370.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 33370.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33370.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 33370.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 33370.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 35038.82, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33370.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXAMBIOPSY OF VAG WSCOPE", "code_information": [ { "code": "57421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5685.6, "discounted_cash": 982.0, "minimum": 128.01, "maximum": 4719.048, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1325.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1375.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1591.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 849.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 831.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1080.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.01 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2171.58, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 849.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5685.6, "discounted_cash": 982.0, "minimum": 128.01, "maximum": 4719.048, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1325.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1375.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1591.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1522.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 849.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 831.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1080.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.01 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2171.58, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 849.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 1", "code_information": [ { "code": "7701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1684.15, "maximum": 1768.36, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 1684.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 1684.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 1684.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 1684.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 1684.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1768.36, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1684.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Abd Les Sc 3 Cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 3097.0, "minimum": 498.64, "maximum": 7544.7, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.64 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7126.0, "minimum": 4799.7176, "maximum": 15088.4186, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8552.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6651.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7965.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7815.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7853.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6017.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8774.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10824.4 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8908.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9977.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11545.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8643.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6467.69 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6397.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11046.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12113.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11858.63 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5307.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6651.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6651.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10690.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6524.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6651.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8729.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6334.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7126.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12751.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6524.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Bartholins Gland/Cyst", "code_information": [ { "code": "56740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9535.84, "discounted_cash": 3451.0, "minimum": 322.12, "maximum": 7914.7472, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4660.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4832.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5592.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5350.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6012.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3969.75, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3797.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5177.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2218.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3624.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 322.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 322.12 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2111.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2112.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7632.28, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4314.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6012.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7531.0, "minimum": 5090.2806, "maximum": 20531.21, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9037.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7024.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8448.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8289.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8328.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6355.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9306.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11479.68 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9413.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10543.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 12200.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9166.65 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6859.23 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6757.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11673.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19504.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19094.03 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5684.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7359.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7024.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7024.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11296.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6891.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7024.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7531.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7531.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6690.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7531.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20531.21 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc foottoe tum sc 1.5 cm>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5568.44, "discounted_cash": 3097.0, "minimum": 342.66, "maximum": 5568.44, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.66 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1852.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5568.44, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 2", "code_information": [ { "code": "1102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5373.8, "maximum": 5642.49, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5373.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 5373.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5373.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 5373.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 5373.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5642.49, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5373.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Forearm Tum Deep 3 Cm/>", "code_information": [ { "code": "25073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104.0, "discounted_cash": 3097.0, "minimum": 574.37, "maximum": 10876.32, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 574.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 574.37 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 3", "code_information": [ { "code": "7593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8582.04, "maximum": 9011.14, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9011.14, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8582.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 4", "code_information": [ { "code": "7704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8310.15, "maximum": 8725.66, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 8310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 8310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 8310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8725.66, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8310.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg >4 Cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11495.7, "discounted_cash": 3097.0, "minimum": 273.9, "maximum": 9541.431, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.9 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1549.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl-Sodium Chloride Iv Soln 2500 Mg/250Ml", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "67457065725", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "EATING DISORDERS - SOI : 4", "code_information": [ { "code": "7594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35453.97, "maximum": 37226.67, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35453.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 35453.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35453.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 35453.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 35453.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 37226.67, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35453.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dstrj Nulyt Agt Gnclr Nrv", "code_information": [ { "code": "64624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6404.0, "discounted_cash": 2082.0, "minimum": 143.58, "maximum": 5758.2163, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2498.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1109.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1109.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2811.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2915.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3373.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1109.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2394.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1109.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2290.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1236.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1165.1 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3123.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1165.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1109.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1109.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4604.01, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2602.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8039.0, "discounted_cash": 1761.0, "minimum": 156.11, "maximum": 7009.0263, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4427.78 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4334.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1101.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1101.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.11 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1048.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4427.78 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Esoph Egd Dilation <30 Mm", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8014.67, "discounted_cash": 2046.0, "minimum": 150.06, "maximum": 8206.2266, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2455.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3171.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1943.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2762.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2864.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3314.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3171.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2438.58 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2353.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2387.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2250.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.17 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3069.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2107.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.06 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 835.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4524.26, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2557.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2438.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Egd Dilate Stricture", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10068.0, "discounted_cash": 2046.0, "minimum": 176.07, "maximum": 8356.44, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2455.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 3171.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1943.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2762.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2864.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3314.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3171.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2438.58 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2353.19, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2387.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2250.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3069.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2107.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.07 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 835.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4524.26, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2557.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2046.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2438.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2107.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bronchoscope/Brush", "code_information": [ { "code": "31623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20135.5, "discounted_cash": 1898.0, "minimum": 130.35, "maximum": 16712.465, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2562.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2657.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3074.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 2829.55, "10th_percentile": 2829.55, "90th_percentile": 2829.55, "count": "1 through 10" }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2791.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2847.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4196.52, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2791.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hand Les Sc 1.5 Cm/>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 1761.0, "minimum": 440.26, "maximum": 9210.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.26 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1130.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7375.0, "minimum": 4978.5256, "maximum": 13288.25, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7375.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7375.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7330.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7375.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13288.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6750.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8850.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6881.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 8262.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 8107.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8145.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 6225.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 9101.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 11227.65 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9219.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10325.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11948.55, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8965.4 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6708.64 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6619.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11432.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12623.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12358.07 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5540.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7208.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6553.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6881.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6881.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11063.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6750.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6881.16, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Egd Endoscopic Stent Place", "code_information": [ { "code": "43266", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10668.0, "discounted_cash": 6473.0, "minimum": 214.29, "maximum": 25751.414, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7768.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 10034.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6797.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6150.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 8739.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9063.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10487.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10034.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7444.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7121.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6797.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3416.89 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6797.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9710.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3416.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6668.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6797.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.29 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3252.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10668.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8092.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6473.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6668.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Egd Diagnostic Brush Wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5408.0, "discounted_cash": 967.0, "minimum": 121.59, "maximum": 4550.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1160.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1499.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 918.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1305.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1354.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1566.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1499.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2438.58 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1112.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2387.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1063.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1450.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.59 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 835.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2138.43, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1208.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2438.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Les Sc < 3 Cm", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 1761.0, "minimum": 334.68, "maximum": 9210.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2108.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2108.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 334.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 334.68 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2006.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14724.95, "maximum": 15461.2, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14724.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 14724.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14724.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 14724.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 14724.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15461.2, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14724.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Egd Remove Foreign Body", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7758.0, "discounted_cash": 967.0, "minimum": 174.68, "maximum": 6439.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1160.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1499.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 918.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1305.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1354.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1566.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1499.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2438.58 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1112.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2387.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1063.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1450.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.68 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 835.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2138.43, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1208.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2438.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXC NECK TUM DEEP < 5 CM", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9870.76, "discounted_cash": 3097.0, "minimum": 488.0, "maximum": 8192.7308, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2108.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2108.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 558.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 558.05 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2006.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9956.46, "maximum": 10454.28, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9956.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 9956.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9956.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 9956.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 9956.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10454.28, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9956.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 2", "code_information": [ { "code": "3242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10910.16, "maximum": 11455.67, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10910.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10910.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10910.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10910.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10910.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11455.67, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10910.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Neck Tum Deep 5 Cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11924.7, "discounted_cash": 3097.0, "minimum": 787.82, "maximum": 9897.501, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2108.26 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2108.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 787.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 787.82 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2006.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2007.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EX ARMELBOW TUM DEEP 5 CM>", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6552.0, "discounted_cash": 3097.0, "minimum": 754.19, "maximum": 6552.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", 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Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6552.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6552.0, "discounted_cash": 3097.0, "minimum": 754.19, "maximum": 6552.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6552.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Endoscopic Injection/Implant", "code_information": [ { "code": "51715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8039.0, "discounted_cash": 3758.0, "minimum": 200.32, "maximum": 8039.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5074.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5262.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6089.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5826.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8039.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4322.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8039.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5638.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2608.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.32 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2483.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2484.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8039.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4698.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8039.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 2", "code_information": [ { "code": "3262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10569.67, "maximum": 11098.15, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10569.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "case rate", "standard_charge_dollar": 10569.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10569.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "case rate", "standard_charge_dollar": 10569.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "case rate", "standard_charge_dollar": 10569.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11098.15, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10569.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Rect Tum Transanal Full", "code_information": [ { "code": "45172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39754.0, "discounted_cash": 2959.0, "minimum": 892.77, "maximum": 32995.82, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3995.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4143.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4794.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3255.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2048.3 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4439.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2048.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 892.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 892.77 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1949.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6544.27, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3699.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc abd tum over 10 cm", "code_information": [ { "code": "49205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13552.0, "minimum": 2710.4, "maximum": 11248.16, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3168.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 } ] }, { "setting": "outpatient", "gross_charge": 13552.0, "minimum": 2710.4, "maximum": 11248.16, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3328.23 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3168.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3169.74 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42737.0, "minimum": 3685.5, "maximum": 87782.6377, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 51285.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39602.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 50457.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 49508.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 49744.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 35831.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 55582.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 68564.14 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 53422.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 59832.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 69235.14, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 54749.2 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 40967.78 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 38094.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 66243.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 33403.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41488.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39602.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39602.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64106.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 38848.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39602.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42737.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42737.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4599.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 42737.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38848.61, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54885.0, "minimum": 7371.0, "maximum": 88913.9106, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 65862.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50843.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 64952.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 63730.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 64033.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 46001.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 71549.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 88260.05 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 68606.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 76839.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 88913.91, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 70476.6 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 52736.29 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48906.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 85071.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 42534.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53264.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50843.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 50843.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 82327.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 49874.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50843.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 54885.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54885.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48422.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 54885.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 49874.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Rect Tum Transanal Part", "code_information": [ { "code": "45171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16644.4, "discounted_cash": 2959.0, "minimum": 682.71, "maximum": 13814.852, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1949.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6544.27, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3699.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3995.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4143.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4794.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4587.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3403.85, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3255.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2048.3 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4439.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2048.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3107.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 682.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 682.71 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Abdl Tum Deep 5 Cm/>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 3097.0, "minimum": 751.92, "maximum": 7544.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.92 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc skin abd", "code_information": [ { "code": "15830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29589.97, "discounted_cash": 7080.0, "minimum": 558.0, "maximum": 24559.6751, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8497.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 10975.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6726.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9559.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9913.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11470.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10975.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8142.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7788.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10621.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7293.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1217.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1217.95 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1549.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15655.76, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8851.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1277.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7293.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 29590.0, "discounted_cash": 7080.0, "minimum": 558.0, "maximum": 24559.6751, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8497.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 10975.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 6726.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9559.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9913.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11470.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10975.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5882.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8142.98, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7788.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10621.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7293.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7434.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1217.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1217.95 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1549.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15655.76, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8851.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1277.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5882.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7293.28, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXC ARMELBOW LES SC 3 CM>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8066.62, "discounted_cash": 3097.0, "minimum": 450.57, "maximum": 6848.5504, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 450.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 450.57 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ephedrine Sulfate Inj 50 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00781326971", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.1, "median_amount": 6.31, "10th_percentile": 6.31, "90th_percentile": 6.31, "count": "1 through 10" } ] } ] }, { "description": "Exc tr-ext b9+marg 0.5 cm<", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5097.88, "discounted_cash": 755.0, "minimum": 81.67, "maximum": 4550.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 717.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1019.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1057.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1223.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1199.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 830.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.67 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 364.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 943.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11674.5, "discounted_cash": 3097.0, "minimum": 818.06, "maximum": 12381.027, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.06 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6848.55, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext Mal+Marg 0.5 Cm/<", "code_information": [ { "code": "11600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8809.0, "discounted_cash": 755.0, "minimum": 118.25, "maximum": 7311.47, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 906.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 717.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 1019.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1057.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1223.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 365.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1170.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1199.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 830.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 364.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.57, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 943.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111.0, "discounted_cash": 1761.0, "minimum": 365.11, "maximum": 12542.13, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1225.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.11 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6970.0, "minimum": 4687.324, "maximum": 19954.9505, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8364.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6506.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice Illinois", "methodology": "case rate", "standard_charge_dollar": 7779.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue choice options", "methodology": "case rate", "standard_charge_dollar": 7632.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7669.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "case rate", "standard_charge_dollar": 5886.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill HMO", "methodology": "case rate", "standard_charge_dollar": 8569.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill PPO", "methodology": "case rate", "standard_charge_dollar": 10570.93 }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8713.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9758.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 11292.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8441.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA One Health HMO and Local Plus", "methodology": "case rate", "standard_charge_dollar": 6316.24 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6258.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10804.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13828.21 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13537.09 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO Health & Welfare", "methodology": "case rate", "standard_charge_dollar": 5381.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6816.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6506.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6506.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10455.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6382.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6506.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6970.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6970.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6196.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6970.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14556.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6382.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Excise foot tendon sheath - 28088 - ", "code_information": [ { "code": "28088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5037.0, "discounted_cash": 3489.0, "minimum": 308.47, "maximum": 5037.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5037.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5037.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.47 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1852.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5037.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5037.0, "discounted_cash": 3489.0, "minimum": 308.47, "maximum": 5037.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5037.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5037.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1945.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.47 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1852.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1853.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5037.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5037.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc foottoe tum sc < 1.5 cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5196.99, "discounted_cash": 1761.0, "minimum": 266.23, "maximum": 5196.99, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5196.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5196.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.23 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5196.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Excise Intrspinl Lesion Lmbr", "code_information": [ { "code": "63267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26122.7, "discounted_cash": 7737.0, "minimum": 1467.0, "maximum": 21681.841, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3035.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4493.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1619.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1619.67 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4277.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4279.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17108.25, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXC FOREARM LES SC 3 CM>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7038.26, "discounted_cash": 1761.0, "minimum": 462.04, "maximum": 5841.7558, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1933.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 1467.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1547.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 462.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 462.04 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1472.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1473.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "EXCISE MANDIBLE LESION", "code_information": [ { "code": "21040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8623.46, "discounted_cash": 3535.0, "minimum": 365.11, "maximum": 7816.9684, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4242.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 5480.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 3358.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4772.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4949.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5727.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5480.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6840.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4065.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6696.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3889.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2380.54 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5303.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2380.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3712.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.11 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2266.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7816.97, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4419.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6840.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc hand tum deep < 1.5 cm", "code_information": [ { "code": "26116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4000.5, "discounted_cash": 1761.0, "minimum": 488.0, "maximum": 4000.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4000.5 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4000.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550.77 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1130.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4000.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4000.5, "discounted_cash": 1761.0, "minimum": 488.0, "maximum": 4000.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1696.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Dual Eligible HMO", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CIGNA", "plan_name": "CIGNA COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 4000.5 }, { "payer_name": "CIGNA", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health Of illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health System", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN (Healthcare Finest Network) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4000.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1545.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1187.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Providers Partners Health Plan", "plan_name": "Providers Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550.77 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1130.78 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1131.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3894.04, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4000.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Providers Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Excise Parotid Gland/Lesion", "code_information": [ { "code": "42415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25146.0, "discounted_cash": 6312.0, "minimum": 1034.06, "maximum": 20871.18, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7575.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "s