{ "hospital_name": "Saint Mary of Nazareth Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Saint Mary of Nazareth Hospital" ], "hospital_address": [ "2233 W. Division St., Chicago, Illinois 60622" ], "license_information": { "license_number": "992171028", "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": "Brent Cope" }, "type_2_npi": [ "1265270607", "1750190542", "1578372363" ], "standard_charge_information": [ { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15266.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16029.68, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.55, "additional_payer_notes": "105% 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5573.53, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4021.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4222.48, "additional_payer_notes": "105% 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": "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": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "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": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8971.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9419.73, "additional_payer_notes": "105% 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" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10487.0, "minimum": 6255.0038, "maximum": 16989.7824, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12585.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.88, "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": 10306.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10277.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10426.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10228.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9325.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11484.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13109.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14166.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14682.53, "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": 16989.78, "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": 9815.88, "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": 9815.88, "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": 9914.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16255.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10849.31 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 11213.3 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11536.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.88, "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": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10306.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15731.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10110.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10306.67, "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": 10487.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10487.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9008.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10487.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9815.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10110.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ablate inf turbinate submuc", "code_information": [ { "code": "30802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8359.0, "discounted_cash": 1654.0, "minimum": 196.92, "maximum": 6687.2, "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": 1055.0 }, { "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 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": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% 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": 365.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 2167.24 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% 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": "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": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "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": 3447.29 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 196.92, "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": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.92 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3281.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 8359.0, "discounted_cash": 1654.0, "minimum": 196.92, "maximum": 6687.2, "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": 1055.0 }, { "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 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": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% 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": 365.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 2167.24 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% 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": "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": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "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": 3447.29 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 196.92, "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": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.92 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3281.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare 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": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3860.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4053.1, "additional_payer_notes": "105% 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7975.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8373.84, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4266.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.91, "additional_payer_notes": "105% 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 WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9086.0, "minimum": 4840.67, "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": 10904.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8523.14, "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": 8949.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8623.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8747.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8581.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8096.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9635.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11358.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11886.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12721.35, "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": 14720.42, "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": 8523.14, "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": 8523.14, "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": 8608.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14084.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9425.59 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8581.44 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9995.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8523.14, "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": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8949.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13630.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8778.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8949.3, "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": 9086.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9086.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4840.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9086.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8523.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.83, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5982.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.6, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15300.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16065.79, "additional_payer_notes": "105% 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 & 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7805.03, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5313.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5578.86, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 23643.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24825.33, "additional_payer_notes": "105% 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 ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10118.0, "minimum": 3273.2, "maximum": 16392.213, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12142.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9475.47, "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": 9949.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9842.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9984.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9794.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9001.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10997.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12648.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13566.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14166.11, "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": 16392.21, "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": 9475.47, "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": 9475.47, "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": 9570.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15683.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9665.56 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 9620.54 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11130.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9475.47, "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": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9949.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15177.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9759.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9949.24, "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": 10118.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10118.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6932.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10118.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9475.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9759.73, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16599.0, "minimum": 8126.88, "maximum": 34922.48, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19919.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15456.2, "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": 16229.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17495.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17748.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17411.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14683.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19549.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20749.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 24116.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23239.33, "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": 26891.22, "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": 15456.2, "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": 15456.2, "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": 15610.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25729.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15897.87 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 34187.27 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18259.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15456.2, "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": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16229.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24899.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15919.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 16229.01, "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": 16599.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16599.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8126.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16599.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15456.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15919.89, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9853.0, "minimum": 5937.0642, "maximum": 25794.95, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11824.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "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": 9692.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9529.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9667.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9483.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8769.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10648.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12317.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13135.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13795.5, "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": 15963.37, "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": 9231.18, "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": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9323.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15273.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9871.26 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 25251.9 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10839.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9692.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14780.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9508.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9692.74, "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": 9853.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9853.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11468.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9853.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9508.12, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2724.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2861.08, "additional_payer_notes": "105% 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 AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25272.0, "minimum": 16307.7226, "maximum": 62578.07, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 30327.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23460.1, "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": 24633.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 27738.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 28139.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 27605.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 22287.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 30995.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 31590.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 38235.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 35381.89, "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": 40941.9, "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": 23460.1, "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": 23460.1, "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": 23694.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 39172.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 27541.71 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 61260.63 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27800.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 23460.1, "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": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 24633.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37909.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 24163.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 24633.11, "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": 25272.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25272.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31553.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 25272.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23460.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 24163.9, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3113.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3269.12, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8580.3, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5046.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5298.51, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005.53, "additional_payer_notes": "105% 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 LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49433.0, "minimum": 19927.7332, "maximum": 166912.52, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59320.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45756.1, "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": 48043.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 56272.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 57084.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 56001.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43468.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 62878.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 61791.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 77565.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 69206.84, "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": 80082.21, "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": 45756.1, "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": 45756.1, "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": 46213.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 76621.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 55731.77 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 163398.57 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 54376.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45756.1, "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": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 48043.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 74150.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 47128.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 48043.91, "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": 49433.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49433.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 96102.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49433.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45756.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 47128.78, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5391.06, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9845.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10338.17, "additional_payer_notes": "105% 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 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": "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" }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3095.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3250.79, "additional_payer_notes": "105% 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" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11881.0, "minimum": 5095.0, "maximum": 19247.9166, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14257.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.2, "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": 11657.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11923.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12096.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11866.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10547.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13323.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14851.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16436.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16634.0, "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": 19247.92, "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": 11102.2, "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": 11102.2, "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": 11213.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18416.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14037.61 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13069.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.2, "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": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11657.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17822.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11435.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11657.31, "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": 11881.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11881.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5095.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11881.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11435.27, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5655.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5938.45, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2916.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3062.64, "additional_payer_notes": "105% 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4015.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.94, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.74, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7248.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7611.21, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3954.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.2, "additional_payer_notes": "105% 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 35517.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 37293.45, "additional_payer_notes": "105% 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": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9761.0, "minimum": 5869.3726, "maximum": 39349.63, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11714.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.28, "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": 9603.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9420.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9556.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9375.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8688.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10526.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12202.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12985.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13666.7, "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": 15814.33, "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": 9146.28, "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": 9146.28, "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": 9237.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15130.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9294.51 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 38521.21 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10738.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.28, "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": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9603.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14642.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9420.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9603.59, "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": 9761.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9761.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9761.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9146.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.67, "additional_payer_notes": "103.00% 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11044.47, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3979.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4178.39, "additional_payer_notes": "105% 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 MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8604.0, "minimum": 3267.22, "maximum": 13940.0676, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10325.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.62, "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": 8482.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8054.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8170.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8015.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7674.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9000.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10756.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11102.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12046.97, "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": 13940.07, "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": 8078.62, "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": 8078.62, "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": 8159.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13337.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8146.93 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9465.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.62, "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": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12907.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8320.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.55, "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": 8604.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3267.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8604.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8320.98, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4505.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4730.6, "additional_payer_notes": "105% 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 MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15707.0, "minimum": 8781.0814, "maximum": 53181.15, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18848.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.8, "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": 15364.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16442.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16679.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16363.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13901.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18372.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19634.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22664.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21990.19, "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": 25445.79, "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": 14632.8, "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": 14632.8, "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": 14779.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24346.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16550.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 52061.55 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17278.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.8, "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": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15364.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23560.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15071.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15364.44, "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": 15707.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15707.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16076.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15707.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15071.78, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7821.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8212.74, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5660.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5943.26, "additional_payer_notes": "105% 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": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20808.0, "minimum": 13368.9122, "maximum": 49396.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24969.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19340.0, "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": 20307.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22466.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 22790.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 22358.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18373.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25103.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 26010.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 30967.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 29131.38, "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": 33709.17, "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": 19340.0, "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": 19340.0, "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": 19533.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 32252.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 22979.16 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 48356.24 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22888.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19340.0, "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": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20307.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31212.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19920.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 20307.0, "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": 20808.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20808.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28690.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20808.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19340.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19920.2, "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": 18976.0, "minimum": 6613.2788, "maximum": 41455.55, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22772.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.0, "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": 18532.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20303.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20596.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20205.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16767.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22686.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23720.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27986.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26567.51, "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": 30742.4, "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": 17650.0, "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": 17650.0, "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": 17826.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29414.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19716.3 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 40582.8 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20874.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.0, "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": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28465.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18179.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.5, "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": 18976.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18976.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29840.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18976.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18179.5, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6266.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6580.14, "additional_payer_notes": "105% 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 MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7792.0, "minimum": 4420.3892, "maximum": 30117.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9351.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7328.93, "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": 7695.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7095.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7197.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7060.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6962.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7928.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9740.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9779.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10909.63, "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": 12624.0, "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": 7328.93, "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": 7328.93, "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": 7402.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12078.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7471.5 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 29483.52 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8571.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7328.93, "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": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7695.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11688.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7548.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7695.38, "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": 7792.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7792.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8679.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7792.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7328.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7548.8, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8705.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9140.36, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11724.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12310.82, "additional_payer_notes": "105% 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 MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6982.0, "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": 8379.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6581.64, "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": 6910.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6138.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6227.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6109.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6252.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6859.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8728.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8461.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9775.93, "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": 11312.15, "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": 6581.64, "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": 6581.64, "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": 6647.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10823.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 5660.6 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14616.37 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7681.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6581.64, "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": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6910.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10474.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6779.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 6910.72, "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": 6982.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6982.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6576.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6982.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6581.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6779.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41383.0, "minimum": 20851.605, "maximum": 67041.0594, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 49660.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38327.3, "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": 40243.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 46765.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 47440.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 46539.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36410.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 52254.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 51729.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 64461.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 57936.72, "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": 67041.06, "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": 38327.3, "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": 38327.3, "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": 38710.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 64144.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 49273.6 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 42582.22 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 45521.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 38327.3, "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": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 40243.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 62075.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 39477.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 40243.67, "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": 41383.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41383.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 41383.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38327.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 39477.12, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2873.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3017.68, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10951.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11498.89, "additional_payer_notes": "105% 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": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13929.0, "minimum": 8935.9298, "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": 16715.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.4, "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": 13642.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14342.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14550.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14273.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12342.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16026.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17412.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 19770.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19501.65, "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": 22566.2, "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": 12992.4, "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": 12992.4, "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": 13122.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21591.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 14448.94 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 32453.36 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15322.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.4, "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": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13642.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20894.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13382.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13642.02, "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": 13929.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13929.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17398.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13929.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12992.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13382.17, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 20399.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21419.3, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 1960.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2058.21, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3063.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3217.17, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16106.82, "additional_payer_notes": "105% 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 LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19888.0, "minimum": 11651.103, "maximum": 115699.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23865.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18491.0, "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": 19415.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21379.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21688.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21276.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17566.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23889.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24860.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29469.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27843.37, "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": 32218.75, "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": 18491.0, "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": 18491.0, "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": 18675.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30826.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 21536.28 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 113263.63 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21876.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18491.0, "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": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19415.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29832.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19045.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19415.55, "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": 19888.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19888.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21296.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19888.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18491.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19045.73, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 19250.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20212.75, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5865.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6158.9, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3767.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3956.21, "additional_payer_notes": "105% 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": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12369.0, "minimum": 7787.727, "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": 14843.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11552.3, "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": 12129.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12500.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12680.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12439.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10974.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13967.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15461.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17230.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17316.89, "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": 20038.12, "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": 11552.3, "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": 11552.3, "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": 11667.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19172.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12812.47 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 28317.78 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13606.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11552.3, "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": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12129.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18553.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11898.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12129.92, "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": 12369.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12369.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14885.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12369.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11552.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11898.87, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 32321.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33937.47, "additional_payer_notes": "105% 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": "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": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12993.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13643.52, "additional_payer_notes": "105% 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" }, { "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" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14071.0, "minimum": 7767.02, "maximum": 22795.3764, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16885.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.0, "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": 13779.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14510.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14719.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14440.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12466.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16213.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17589.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20000.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19699.71, "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": 22795.38, "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": 13123.0, "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": 13123.0, "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": 13254.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21810.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 14599.18 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 16668.79 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15478.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.0, "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": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13779.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21106.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13516.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13779.15, "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": 14071.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7767.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14071.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13516.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8060.0, "minimum": 4617.7166, "maximum": 33813.19, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9672.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7576.42, "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": 7955.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7411.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7518.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7376.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7197.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8281.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10075.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10216.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11285.09, "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": 13058.46, "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": 7576.42, "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": 7576.42, "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": 7652.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12494.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7311.18 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 33101.33 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8866.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7576.42, "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": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7955.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12091.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7803.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7955.24, "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": 8060.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8060.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9721.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8060.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7576.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7803.71, "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": 7232.0, "minimum": 4008.4922, "maximum": 20783.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8679.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6812.31, "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": 7152.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6433.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6526.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6403.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6471.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7189.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9040.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8868.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10125.88, "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": 11717.09, "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": 6812.31, "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": 6812.31, "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": 6880.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11210.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 5909.65 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7930.28 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7956.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6812.31, "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": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7152.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10849.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7016.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7152.93, "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": 7232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20783.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7232.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6812.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7016.68, "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": 7139.0, "minimum": 2430.0, "maximum": 11565.2286, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8566.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6725.81, "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": 7062.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6323.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6414.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6292.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6389.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7065.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8923.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8716.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9994.64, "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": 11565.23, "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": 6725.81, "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": 6725.81, "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": 6793.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11065.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6292.8 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7611.95 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7852.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6725.81, "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": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7062.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10708.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6927.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7062.1, "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": 7139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4071.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7139.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6725.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.58, "additional_payer_notes": "103.00% of Medicare 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": 16931.0, "minimum": 5832.0, "maximum": 27428.3334, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 20317.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.1, "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": 16550.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17887.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 18145.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17801.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14974.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19987.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21163.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 24656.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23703.5, "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": 27428.33, "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": 15762.1, "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": 15762.1, "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": 15919.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 26243.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 17955.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 24492.34 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18624.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.1, "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": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16550.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25396.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16234.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 16550.21, "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": 16931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12371.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16931.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15762.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16234.96, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8154.68, "additional_payer_notes": "105% 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": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8762.0, "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": 10514.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "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": 8634.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8240.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8359.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8200.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7812.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9207.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10952.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11358.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12266.9, "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": 14194.55, "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": 8223.59, "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": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8305.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13581.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8243.86 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 10698.94 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9638.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8634.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13143.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8470.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8634.77, "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": 8762.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10543.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8762.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8223.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8470.3, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6737.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7074.72, "additional_payer_notes": "105% 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 ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9446.0, "minimum": 4009.5, "maximum": 15303.9294, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11336.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.54, "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": 9298.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9048.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9179.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9005.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8412.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10111.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11808.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12472.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13225.62, "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": 15303.93, "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": 8855.54, "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": 8855.54, "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": 8944.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14642.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8895.22 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8925.4 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10391.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.54, "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": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9298.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14170.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9121.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9298.32, "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": 9446.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9446.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9446.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12110.0, "minimum": 5997.0458, "maximum": 66117.76, "payers_information": [ { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12110.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12110.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26032.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12110.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11653.11, "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": 14532.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.7, "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": 11879.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12194.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12370.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12135.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10748.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13626.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15138.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16809.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16954.78, "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": 19619.11, "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": 11313.7, "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": 11313.7, "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": 11426.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18771.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10879.56 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 64725.81 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13321.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11313.7, "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": 11313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11879.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18165.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11653.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11879.39, "additional_payer_notes": "105.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3179.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3338.53, "additional_payer_notes": "105% 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3428.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3600.44, "additional_payer_notes": "105% 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": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11558.0, "minimum": 7191.2746, "maximum": 18724.851, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13870.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10804.3, "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": 11344.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11542.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11709.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11487.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10264.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12897.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14448.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15910.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16181.97, "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": 18724.85, "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": 10804.3, "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": 10804.3, "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": 10912.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17915.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 11481.51 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18208.52 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12714.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10804.3, "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": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11344.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17337.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11128.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11344.52, "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": 11558.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11558.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16459.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11558.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10804.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11128.43, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4613.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4844.09, "additional_payer_notes": "105% 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": 16379.0, "minimum": 6365.8302, "maximum": 26535.4866, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19655.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.5, "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": 16016.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17236.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17485.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17153.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14490.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19260.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20474.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23758.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22931.9, "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": 26535.49, "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": 15253.5, "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": 15253.5, "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": 15406.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25388.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 17523.25 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 24698.61 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18017.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.5, "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": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16016.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24569.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15711.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 16016.18, "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": 16379.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16379.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16379.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15253.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15711.11, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 14171.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14879.75, "additional_payer_notes": "105% 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": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17970.0, "minimum": 10758.7594, "maximum": 59651.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21565.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16721.7, "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": 17557.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19115.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19391.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19023.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15885.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21359.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22463.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 26348.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25159.19, "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": 29112.78, "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": 16721.7, "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": 16721.7, "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": 16888.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27854.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 18717.07 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 58395.29 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19767.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16721.7, "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": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17557.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26956.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17223.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 17557.79, "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": 17970.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17970.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21744.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17970.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16721.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17223.35, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2516.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2642.27, "additional_payer_notes": "105% 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": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7567.0, "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": 9081.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.48, "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": 7477.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6829.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6928.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6796.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6765.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7631.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9459.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9414.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10594.91, "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": 12259.82, "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": 7121.48, "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": 7121.48, "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": 7192.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11730.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6696.12 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7721.98 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8324.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.48, "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": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7477.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11351.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7335.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7477.55, "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": 7567.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4661.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7567.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.12, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2137.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2244.17, "additional_payer_notes": "105% 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": 33188.0, "minimum": 23105.8252, "maximum": 83633.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39826.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.7, "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": 32302.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 37086.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 37622.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 36908.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29226.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 41440.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 41485.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 51120.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46463.68, "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": 53765.11, "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": 30764.7, "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": 30764.7, "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": 31072.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51441.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 35968.08 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 81872.72 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36507.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.7, "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": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 32302.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49782.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 31687.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 32302.94, "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": 33188.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33188.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41785.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33188.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30764.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 31687.64, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6114.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6419.94, "additional_payer_notes": "105% 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", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 106092.0, "minimum": 76746.3094, "maximum": 171869.3478, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 127310.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 98042.1, "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": 102944.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 123184.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 124963.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 122591.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 93140.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 137645.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 132615.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 169798.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 148529.07, "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": 171869.35, "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": 98042.1, "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": 98042.1, "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": 99022.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 164442.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 132105.45 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 116701.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 98042.1, "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": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 102944.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 159138.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 100983.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 102944.21, "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": 106092.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 106092.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 123948.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 106092.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 98042.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 100983.36, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 125164.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 131422.82, "additional_payer_notes": "105% 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 & 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12180.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12789.68, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 87176.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 91535.24, "additional_payer_notes": "105% 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- 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 97904.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 102799.84, "additional_payer_notes": "105% 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": "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": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "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": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4751.55, "additional_payer_notes": "105% 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" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3446.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3619.21, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3823.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4014.27, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 212385.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 223005.03, "additional_payer_notes": "105% 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": "Alys cplx sppn npgt wprgrm", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5804.0, "discounted_cash": 101.0, "minimum": 38.32, "maximum": 4759.28, "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 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": 178.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 96.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.77 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 111.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.83 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.77 }, { "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": 187.77 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 38.32, "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": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 178.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.83 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5804.0, "discounted_cash": 101.0, "minimum": 38.32, "maximum": 4759.28, "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 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": 178.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 96.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.77 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 111.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.83 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.37, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.77 }, { "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": 187.77 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 38.32, "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": 101.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.32 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 178.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.83 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.41, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4424.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4645.91, "additional_payer_notes": "105% 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": "Amiodarone HCl Inj 900 MG/18ML (50 MG/ML)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00143987501", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 7.53, "10th_percentile": 7.53, "90th_percentile": 11.29, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11947.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12545.23, "additional_payer_notes": "105% 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": "Ampicillin & Sulbactam Sodium For Inj 3 (2-1) GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00641611701", "type": "NDC" }, { "code": "J0295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 4.66, "10th_percentile": 4.66, "90th_percentile": 4.66, "count": "1 through 10" } ] } ] }, { "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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5882.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6176.79, "additional_payer_notes": "105% 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" }, { "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" } ] } ] }, { "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": 13800.0, "minimum": 8840.7784, "maximum": 43586.88, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16560.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "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": 13516.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14190.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14395.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14121.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12229.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15856.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17250.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 19559.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19320.6, "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": 22356.7, "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": 12873.1, "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": 12873.1, "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": 13001.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21390.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15224.32 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 42669.26 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15180.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "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": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13516.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20700.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13259.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13516.76, "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": 13800.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13800.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17686.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13800.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12873.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13259.29, "additional_payer_notes": "103.00% of Medicare 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": 26525.0, "minimum": 13226.5576, "maximum": 62744.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 31830.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.8, "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": 25846.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 29217.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 29639.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 29077.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23385.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 32647.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 33156.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 40274.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 37135.29, "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": 42970.84, "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": 24615.8, "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": 24615.8, "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": 24861.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 41114.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 29363.71 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 61423.73 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 29177.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.8, "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": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25846.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39787.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 25354.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 25846.59, "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": 26525.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26525.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21992.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 26525.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25354.27, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11504.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12079.89, "additional_payer_notes": "105% 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": "Ampicillin & Sulbactam Sodium For Inj 1.5 (1-0.5) GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567021010", "type": "NDC" }, { "code": "J0295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 4.66, "10th_percentile": 4.66, "90th_percentile": 4.66, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 14160.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14868.4, "additional_payer_notes": "105% 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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12028.0, "minimum": 7536.7572, "maximum": 19485.5382, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14433.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11237.6, "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": 11799.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12097.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12271.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12038.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10675.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13517.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15035.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16674.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16839.35, "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": 19485.54, "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": 11237.6, "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": 11237.6, "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": 11349.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18643.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 11727.54 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 17449.99 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13230.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11237.6, "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": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11799.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18042.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11574.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11799.48, "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": 12028.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9079.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12028.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11574.73, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7343.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7710.3, "additional_payer_notes": "105% 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": "AMPUTATION OF FINGERTHUMB", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5225.67, "discounted_cash": 3489.0, "minimum": 488.0, "maximum": 5225.67, "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": 1411.0 }, { "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 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": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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": 5225.67, "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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5225.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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": 5225.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 753.72, "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": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.72 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1637.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": 5225.67, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amiodarone HCl in Dextrose 4.21% IV Soln 150 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "43066015010", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 7.53, "10th_percentile": 7.53, "90th_percentile": 11.29, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATE METACARPAL BONE", "code_information": [ { "code": "26910", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3541.5, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 3541.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": 3541.5, "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": 3541.5 }, { "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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 3541.5 }, { "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": 3541.5, "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": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 3541.5 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": 808.91, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 808.91 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2700.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "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": 3541.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 3541.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 3541.5, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 3541.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": 3541.5, "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": 3541.5 }, { "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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 3541.5 }, { "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": 3541.5, "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": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 3541.5 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": 808.91, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 808.91 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2700.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "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": 3541.5, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 3541.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.5, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.62, "additional_payer_notes": "105% 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 FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32053.0, "minimum": 17868.8462, "maximum": 86733.79, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38463.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29717.1, "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": 31202.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 35746.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 36262.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 35574.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28231.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39942.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 40066.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 49272.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44874.31, "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": 51925.99, "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": 29717.1, "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": 29717.1, "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": 30014.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49682.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 38970.8 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 84907.82 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35258.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 29717.1, "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": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 31202.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48079.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 30608.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 31202.96, "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": 32053.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32053.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32053.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29717.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 30608.61, "additional_payer_notes": "103.00% of Medicare 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": 21536.0, "minimum": 14532.6202, "maximum": 41411.89, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 32152.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 30150.85, "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": 34888.84, "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": 20012.0, "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": 20012.0, "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": 20212.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 33381.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 21752.06 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 40540.06 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23689.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20012.0, "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": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21012.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32304.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20612.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 21012.6, "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": 21536.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21536.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22065.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 21536.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20612.36, "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": 25843.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20012.0, "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": 21012.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23326.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 23663.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 23213.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19011.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26064.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 26920.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20012.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9340.0, "minimum": 5559.6516, "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": 11209.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.82, "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": 9195.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8923.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9052.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8880.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8319.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9971.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11676.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12300.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13077.37, "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": 15132.39, "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": 8757.82, "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": 8757.82, "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": 8845.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14478.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8882.11 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 12584.15 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10275.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.82, "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": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9195.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14011.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9020.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9195.71, "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": 9340.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9340.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7788.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9340.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9020.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12435.0, "discounted_cash": 3489.0, "minimum": 180.79, "maximum": 9948.0, "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": 1411.0 }, { "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 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": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "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": 2817.98 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.79 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2682.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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 WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39044.0, "minimum": 27414.4594, "maximum": 107695.19, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 46853.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36168.7, "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": 37977.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 44002.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 44638.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 43790.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34360.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 49168.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 48805.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 60653.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 54662.01, "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": 63251.75, "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": 36168.7, "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": 36168.7, "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": 36530.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 60518.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 45219.23 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 105427.92 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 42948.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36168.7, "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": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37977.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 58566.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 37253.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 37977.14, "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": 39044.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39044.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60874.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 39044.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37253.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29891 - ", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23996.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 19196.8, "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": 1620.0 }, { "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 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": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "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": 2820.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 705.4, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 705.4 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 23996.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 19196.8, "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": 1620.0 }, { "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 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": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "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": 2820.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 705.4, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 705.4 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5549.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5827.14, "additional_payer_notes": "105% 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": "Amputation follow-up surgery - 27594 - ", "code_information": [ { "code": "27594", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17952.0, "discounted_cash": 3489.0, "minimum": 552.79, "maximum": 14361.6, "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": 1620.0 }, { "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 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": 5220.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5481.42 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5481.42 }, { "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": 5481.42 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 552.79, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 552.79 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5217.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 17952.0, "discounted_cash": 3489.0, "minimum": 552.79, "maximum": 14361.6, "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": 1620.0 }, { "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 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": 5220.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5481.42 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5481.42 }, { "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": 5481.42 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 552.79, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 552.79 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5217.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9349.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9816.96, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8130.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8536.94, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4965.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5213.83, "additional_payer_notes": "105% 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 follow-up surgery - 27884 - OR36027884", "code_information": [ { "code": "27884", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988.0, "discounted_cash": 3489.0, "minimum": 558.0, "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": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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": 4124.79 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 639.41, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 639.41 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3926.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": 6988.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 3489.0, "minimum": 720.6, "maximum": 5548.5, "payers_information": [ { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 1620.0 }, { "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 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": 5548.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "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": 5548.5 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 720.6 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "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" } ] }, { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 3489.0, "minimum": 720.6, "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": 1620.0 }, { "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 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": 5548.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "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": 5548.5 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 720.6 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.5 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3209.16, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11090.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11644.68, "additional_payer_notes": "105% 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 FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44501.0, "minimum": 27233.677, "maximum": 113070.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 53402.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41205.1, "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": 43265.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 50447.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 51176.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 50205.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39144.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 56370.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 55627.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 69537.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 62302.6, "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": 72093.01, "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": 41205.1, "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": 41205.1, "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": 41617.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 68977.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 50787.06 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 110690.32 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 48952.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 41205.1, "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": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 43265.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 66752.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 42441.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 43265.36, "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": 44501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41762.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 44501.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41205.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 42441.25, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13144.0, "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": 15773.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.6, "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": 12880.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13415.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 13609.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13350.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11654.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14990.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16430.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18491.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18401.98, "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": 21293.72, "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": 12267.6, "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": 12267.6, "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": 12390.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20373.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12693.49 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 20502.94 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14458.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.6, "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": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12880.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19716.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12635.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12880.98, "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": 13144.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14181.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13144.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12267.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12635.63, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4384.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4603.93, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5489.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5763.99, "additional_payer_notes": "105% 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": "Amputation of finger/thumb", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12660.0, "discounted_cash": 3489.0, "minimum": 690.0, "maximum": 10128.0, "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": 1990.0 }, { "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 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": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2836.82 }, { "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": 2836.82 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.44 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2700.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2701.73 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3149.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3307.1, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10624.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11155.91, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7011.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7361.96, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8633.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9064.83, "additional_payer_notes": "105% 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": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38439.0, "minimum": 7238.32, "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": 46127.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35610.5, "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": 37391.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 43288.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 43913.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 43079.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33829.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 48370.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 48049.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 59668.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 53815.08, "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": 62271.73, "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": 35610.5, "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": 35610.5, "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": 35966.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 59580.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 41952.34 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 42283.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35610.5, "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": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37391.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 57659.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 36678.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 37391.03, "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": 38439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7238.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 38439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35610.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36678.82, "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": 61480.0, "minimum": 15923.5, "maximum": 99598.2156, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 73776.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 56873.3, "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": 59716.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 70499.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 71517.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 70159.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 54029.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 78775.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 76850.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 97176.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 86072.53, "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": 99598.22, "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": 56873.3, "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": 56873.3, "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": 57442.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 95294.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 67229.41 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67628.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 56873.3, "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": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 59716.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 92220.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 58579.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 59716.97, "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": 61480.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 61480.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15923.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 61480.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 56873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 58579.5, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 26286.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 27601.34, "additional_payer_notes": "105% 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": "Ankle arthroscopysurgery - 29898 - ", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36680.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 29344.0, "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": 1620.0 }, { "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 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": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "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": 2820.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 581.19 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 36680.0, "discounted_cash": 3489.0, "minimum": 558.0, "maximum": 29344.0, "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": 1620.0 }, { "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 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": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8215.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2820.44 }, { "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": 2820.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 581.19 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2684.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2686.13 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 17943.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18840.33, "additional_payer_notes": "105% 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": "Appendectomy", "code_information": [ { "code": "44960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17118.0, "minimum": 988.63, "maximum": 13694.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.63 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4790.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 } ] }, { "setting": "outpatient", "gross_charge": 17118.0, "minimum": 988.63, "maximum": 13694.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5032.97 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.63 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4790.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4793.3 } ] } ] }, { "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": 18017.0, "minimum": 11943.7358, "maximum": 39132.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21621.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16764.9, "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": 17603.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19170.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19447.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19078.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15926.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21421.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22522.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 26425.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25224.81, "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": 29188.71, "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": 16764.9, "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": 16764.9, "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": 16932.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27927.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19476.32 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 38308.41 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19819.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16764.9, "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": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17603.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27026.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17267.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 17603.15, "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": 18017.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18017.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16041.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18017.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16764.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17267.85, "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": "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" }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5680.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5964.21, "additional_payer_notes": "105% 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" } ] } ] }, { "description": "Appendectomy add-on", "code_information": [ { "code": "44955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19883.6, "minimum": 90.8, "maximum": 15906.88, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.8 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4587.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 } ] }, { "setting": "outpatient", "gross_charge": 19883.6, "minimum": 90.8, "maximum": 15906.88, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.8 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4587.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 } ] } ] }, { "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": 14094.0, "minimum": 9057.2638, "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": 16913.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.6, "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": 13801.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14537.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14747.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14467.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12487.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16244.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17618.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20038.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19732.52, "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": 22833.35, "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": 13144.6, "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": 13144.6, "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": 13276.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21846.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12554.34 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 33577.56 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15504.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.6, "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": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13801.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21141.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13538.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13801.83, "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": 14094.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14094.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14585.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14094.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13144.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13538.94, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8012.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8413.1, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6841.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7183.42, "additional_payer_notes": "105% 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": "Amputation toe & metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9431.0, "discounted_cash": 3489.0, "minimum": 440.58, "maximum": 7714.5107, "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": 1411.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.58 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12803.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13444.03, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4806.11, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8835.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9277.42, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 18008.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18908.42, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7166.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.34, "additional_payer_notes": "105% 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": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7627.0, "minimum": 4299.0552, "maximum": 20111.9354, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7535.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6900.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7000.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6867.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6817.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7710.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9534.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9511.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10678.75, "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": 12356.84, "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": 7176.75, "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": 7176.75, "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": 7248.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11822.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6779.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18032.21 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8390.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.75, "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": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7535.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11441.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7392.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7535.59, "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": 7627.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7627.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5498.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7627.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7392.05, "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": 9153.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.75, "additional_payer_notes": "100.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5548.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.4, "additional_payer_notes": "105% 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": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21709.0, "minimum": 8317.7124, "maximum": 54132.48, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26050.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.4, "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": 21179.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23530.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 23869.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 23416.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19162.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26292.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27136.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 32434.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 30392.66, "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": 35168.64, "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": 20171.4, "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": 20171.4, "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": 20373.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 33649.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 23864.44 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 52992.85 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23879.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.4, "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": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21179.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32563.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20776.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 21179.97, "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": 21709.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21709.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 21709.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20171.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20776.54, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11062.36, "additional_payer_notes": "105% 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": "Av fuse uppr arm basilic", "code_information": [ { "code": "36819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21247.0, "discounted_cash": 5933.0, "minimum": 558.0, "maximum": 16997.6, "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": 1620.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 810.48 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "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": 14921.0, "minimum": 9665.8496, "maximum": 27599.3, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17906.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.9, "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": 14603.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15514.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 15738.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 15439.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13212.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17335.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18652.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 21385.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20890.52, "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": 24173.32, "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": 13907.9, "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": 13907.9, "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": 14046.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23128.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15257.6 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16413.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.9, "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": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14603.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22382.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14325.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 14603.3, "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": 14921.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14921.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14921.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13907.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14325.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7876.0, "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": 9452.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7406.62, "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": 7776.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7194.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7298.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7159.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7036.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8039.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9845.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9917.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11027.49, "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": 12760.38, "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": 7406.62, "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": 7406.62, "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": 7480.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12209.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7040.96 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 11260.77 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8664.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7406.62, "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": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7776.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11815.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7628.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7776.95, "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": 7876.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7876.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7406.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7628.82, "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": 22570.0, "minimum": 15293.8314, "maximum": 36564.858, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27085.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20966.7, "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": 22015.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 24547.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 24902.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 24429.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19918.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 27429.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 28213.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 33837.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 31599.26, "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": 36564.86, "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": 20966.7, "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": 20966.7, "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": 21176.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 34984.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 24983.66 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24827.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20966.7, "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": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22015.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33856.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21595.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 22015.04, "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": 22570.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22570.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22570.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20966.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21595.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Av fuse uppr arm cephalic", "code_information": [ { "code": "36818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21292.0, "discounted_cash": 5933.0, "minimum": 558.0, "maximum": 17033.6, "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": 1620.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 763.97 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3763.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3951.84, "additional_payer_notes": "105% 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": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11719.0, "minimum": 7310.0542, "maximum": 18986.3838, "payers_information": [ { "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": 10953.2, "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": 11062.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18165.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 11331.28 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12891.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10953.2, "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": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11500.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17579.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11281.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11500.86, "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": 11719.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11719.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17752.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11719.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11281.8, "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": 14063.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10953.2, "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": 11500.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11733.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11902.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11676.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10405.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13110.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14649.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16173.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16407.99, "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": 18986.38, "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": 10953.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13164.05 } ] } ] }, { "description": "Av fusion direct any site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16375.0, "discounted_cash": 3367.0, "minimum": 558.0, "maximum": 13100.0, "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": 1620.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3198.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3367.03, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 731.77 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Anoscopy", "code_information": [ { "code": "46615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5422.0, "discounted_cash": 2959.0, "minimum": 93.4, "maximum": 5422.0, "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": 1411.0 }, { "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 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": 2544.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2544.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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": 488.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2671.4 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5422.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5422.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2544.19 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2671.4 }, { "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": 2671.4 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 93.4, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.4 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2542.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2544.19 }, { "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": 5422.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5422.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5422.0, "discounted_cash": 2959.0, "minimum": 93.4, "maximum": 5422.0, "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": 1411.0 }, { "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 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": 2544.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2544.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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": 488.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2671.4 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5422.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5422.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2544.19 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2671.4 }, { "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": 2671.4 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 93.4, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.4 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2542.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2544.19 }, { "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": 5422.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5422.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Appl mltpln uni ext fixj sys", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16002.0, "discounted_cash": 13690.0, "minimum": 558.0, "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": 16002.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 16002.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16002.0, "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": 16002.0, "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": 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", "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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16002.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7367.61 }, { "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": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 7212.5 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% 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": "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "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": 16002.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3052.42 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 1179.66, "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1179.66 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2905.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.07 }, { "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": 16002.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16002.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Artery-vein nonautograft", "code_information": [ { "code": "36830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19246.0, "discounted_cash": 5933.0, "minimum": 690.0, "maximum": 15396.8, "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": 1990.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.31 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3458.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3631.44, "additional_payer_notes": "105% 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": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14750.0, "minimum": 9540.0454, "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": 17700.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.1, "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": 14437.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15312.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 15533.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 15238.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13062.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17110.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18438.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 21107.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20651.15, "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": 23896.33, "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": 13750.1, "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": 13750.1, "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": 13887.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22863.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16225.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.1, "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": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14437.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22126.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14162.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 14437.61, "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": 14750.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14750.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18424.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14750.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Arthrodesis subtalar", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46627.0, "discounted_cash": 13690.0, "minimum": 690.0, "maximum": 37301.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% 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", "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": 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 11978.37 }, { "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": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 11726.19 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% 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": "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 813.23, "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 813.23 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11978.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "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": 16428.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1990.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11911.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12507.52, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6215.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6526.45, "additional_payer_notes": "105% 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": "Arthrp ntrcrp/crp/mtcr ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25802.0, "discounted_cash": 3489.0, "minimum": 785.0, "maximum": 20641.6, "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": 2268.0 }, { "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 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": 4252.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4252.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4465.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 9600.72 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4252.85 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4465.49 }, { "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": 4465.49 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 832.69 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4250.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4252.85 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 23239.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24401.82, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2530.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2656.68, "additional_payer_notes": "105% 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 22989.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24139.28, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3806.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3996.36, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2144.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2251.74, "additional_payer_notes": "105% 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": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24170.0, "minimum": 16470.7712, "maximum": 54166.77, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29004.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "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": 23564.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26437.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 26818.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 26309.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21320.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 29540.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 30213.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 36441.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 33838.7, "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": 39156.21, "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": 22442.8, "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": 22442.8, "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": 22667.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 37464.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 24170.97 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 53026.41 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26587.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "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": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36255.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 23116.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.94, "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": 24170.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24170.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26879.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24170.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23116.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12170.0, "minimum": 7214.2254, "maximum": 30981.94, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14604.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.9, "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": 11937.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12265.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12442.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12206.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10800.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13705.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15213.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16906.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17038.63, "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": 19716.13, "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": 11368.9, "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": 11368.9, "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": 11482.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18864.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 30981.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 11729.55 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 30329.69 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13387.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.9, "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": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11937.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18255.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11709.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11937.35, "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": 12170.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12170.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13627.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12170.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11368.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30981.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11709.97, "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": 28754.75, "discounted_cash": 5334.0, "minimum": 617.86, "maximum": 23003.8, "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": 2268.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.86 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 28754.8, "discounted_cash": 5334.0, "minimum": 617.86, "maximum": 23003.8, "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": 2268.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.86 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 44661.42, "additional_payer_notes": "105% 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" }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 42534.69, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7423.07, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 19153.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20111.48, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12329.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12945.52, "additional_payer_notes": "105% 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": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49720.0, "minimum": 35269.878, "maximum": 92962.9, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59664.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46021.2, "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": 48322.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 56611.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 57428.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 56338.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43720.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 63257.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 62150.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 78033.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 69609.04, "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": 80547.6, "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": 46021.2, "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": 46021.2, "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": 46481.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 77067.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 92962.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 61876.35 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 91005.78 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 54692.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 46021.2, "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": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 48322.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 74581.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 47401.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 48322.26, "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": 49720.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49720.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71884.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49720.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 92962.9 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 47401.84, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 107437.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 112809.05, "additional_payer_notes": "105% 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": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19796.0, "minimum": 5377.4, "maximum": 32071.1076, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23756.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "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": 19327.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21272.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21579.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21169.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17486.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23769.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24746.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29321.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27715.77, "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": 32071.11, "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": 18406.9, "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": 18406.9, "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": 18590.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30685.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 9315.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 18114.11 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 9119.22 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21776.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "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": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19327.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29695.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18959.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19327.25, "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": 19796.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19796.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12955.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19796.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18406.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9315.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18959.11, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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": 15564.0, "minimum": 10139.0522, "maximum": 32174.87, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18677.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.4, "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": 15226.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16274.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16509.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16195.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13776.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18184.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19456.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22432.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21790.92, "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": 25215.2, "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": 14501.4, "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": 14501.4, "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": 14646.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24125.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 32174.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15639.74 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 31497.5 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17121.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.4, "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": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23347.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14936.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.47, "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": 15564.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15564.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15564.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32174.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14936.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Av fusion/forearm vein", "code_information": [ { "code": "36820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27153.0, "discounted_cash": 5933.0, "minimum": 558.0, "maximum": 21722.4, "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": 1620.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 807.45 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3071.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3225.03, "additional_payer_notes": "105% 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": "Biopsy finger joint lining", "code_information": [ { "code": "26110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.0, "discounted_cash": 1714.0, "minimum": 349.1, "maximum": 6822.4, "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": 1055.0 }, { "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 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": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1628.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4636.38 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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": 1720.24 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.1 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1637.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Artery-vein autograft", "code_information": [ { "code": "36825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22691.0, "discounted_cash": 5933.0, "minimum": 690.0, "maximum": 18152.8, "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": 1990.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 878.61 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5356.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5624.6, "additional_payer_notes": "105% 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 of cervix", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448.0, "discounted_cash": 982.0, "minimum": 77.94, "maximum": 4550.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 831.37 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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": 701.18 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.94 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "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": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17712.81, "maximum": 38550.6415, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 20965.72 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 17712.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 20524.34 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20577.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20965.72 } ] } ] }, { "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": 20682.0, "minimum": 13904.2378, "maximum": 50146.55, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24818.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.8, "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": 20184.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22317.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 22639.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 22210.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18262.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24937.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 25852.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 30762.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 28955.19, "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": 33505.29, "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": 19223.8, "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": 19223.8, "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": 19416.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 32057.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 50146.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 21139.01 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 49090.83 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22750.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.8, "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": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20184.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31023.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19800.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 20184.99, "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": 20682.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20682.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20682.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19223.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50146.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19800.51, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy of rectum", "code_information": [ { "code": "45100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 2959.0, "minimum": 337.66, "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": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 1806.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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": 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": 2959.87, "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": 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "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": 4264.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.66 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1805.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "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": 4264.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 4264.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 2959.0, "minimum": 337.66, "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": 3551.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 1806.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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": 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": 2959.87, "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": 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "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": 4264.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.66 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1805.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "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": 4264.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 4264.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Azithromycin Tab 250 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "60687074201", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 28.66, "10th_percentile": 28.66, "90th_percentile": 28.66, "count": "1 through 10" } ] } ] }, { "description": "Arthrp ntrcrpl/crp/mtcrp ssp", "code_information": [ { "code": "25448", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18561.56, "discounted_cash": 3489.0, "minimum": 918.98, "maximum": 14849.248, "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": 2268.0 }, { "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 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": 4252.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4252.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4465.49 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4252.85 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4465.49 }, { "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": 4465.49 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.98 }, { "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": 4252.85 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 18561.6, "discounted_cash": 3489.0, "minimum": 918.98, "maximum": 14849.248, "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": 2268.0 }, { "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 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": 4252.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4252.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4465.49 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4252.85 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4465.49 }, { "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": 4465.49 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.98 }, { "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": 4252.85 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23128.0, "minimum": 15704.4512, "maximum": 49134.72, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27754.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21481.7, "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": 22555.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25207.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 25571.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 25085.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20407.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28166.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 28911.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 34745.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32380.57, "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": 37468.95, "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": 21481.7, "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": 21481.7, "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": 21696.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 35849.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 49134.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 23580.1 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 48100.31 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25441.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 21481.7, "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": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22555.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34693.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 22126.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 22555.79, "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": 23128.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23128.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21034.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 23128.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21481.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49134.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22126.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy of tongue", "code_information": [ { "code": "41105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2992.0, "discounted_cash": 3535.0, "minimum": 109.75, "maximum": 2992.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 1756.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "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": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.75 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1755.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 2992.0, "discounted_cash": 3535.0, "minimum": 109.75, "maximum": 2992.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 1756.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "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": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "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": 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": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.75 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1755.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 2992.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2992.0, "additional_payer_notes": "103.00% of Medicare 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": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 28.66, "10th_percentile": 28.66, "90th_percentile": 28.66, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8044.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8446.28, "additional_payer_notes": "105% 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": "Biopsy of breast open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 4175.0, "minimum": 251.77, "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": 5010.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 1670.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1670.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1754.13 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5533.27 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1670.6 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1754.13 }, { "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": 1754.13 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.77 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1669.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1670.6 }, { "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": 9090.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 11513.0, "discounted_cash": 4175.0, "minimum": 488.0, "maximum": 9231.5662, "payers_information": [ { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "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": 4190.32 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 502.48 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3988.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 1411.0 }, { "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 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": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 56602.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 59432.52, "additional_payer_notes": "105% 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": "Biopsy of foot joint lining", "code_information": [ { "code": "28050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10068.0, "discounted_cash": 3489.0, "minimum": 280.74, "maximum": 8054.4, "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": 1411.0 }, { "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 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": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "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": 2817.98 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 280.74, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.74 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2682.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "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": 19145.0, "minimum": 12773.2772, "maximum": 31015.1754, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22974.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17805.3, "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": 18695.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20502.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20798.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20403.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16915.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22909.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23931.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 28260.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26803.24, "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": 31015.18, "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": 17805.3, "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": 17805.3, "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": 17983.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29675.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21059.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17805.3, "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": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28717.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18339.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18695.57, "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": 19145.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19145.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23517.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19145.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17805.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18339.46, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 67651.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 71034.22, "additional_payer_notes": "105% 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": "Biopsy of prostate - 55705 - OR36055705", "code_information": [ { "code": "55705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.0, "discounted_cash": 3758.0, "minimum": 110.4, "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": 4510.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 2137.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 1649.51 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1614.79 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "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": 2244.72 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 110.4, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.4 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2136.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "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": 7083.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 1649.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 13735.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14421.84, "additional_payer_notes": "105% 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": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53250.0, "minimum": 37867.0642, "maximum": 86266.0206, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 63900.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49278.7, "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": 51742.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 60780.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 61657.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 60487.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46814.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 67915.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 66563.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 83779.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 74550.88, "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": 86266.02, "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": 49278.7, "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": 49278.7, "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": 49771.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 82538.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 60859.98 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 58575.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 49278.7, "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": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51742.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 79875.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 50757.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 51742.64, "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": 53250.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53250.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 53250.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49278.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50757.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy of uterus lining", "code_information": [ { "code": "58100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8087.0, "discounted_cash": 215.0, "minimum": 64.51, "maximum": 6469.6, "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": 1055.0 }, { "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 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": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 204.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 370.26 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.59, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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": 701.18 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 64.51, "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": 215.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.51 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13035.0, "minimum": 7930.7754, "maximum": 21752.69, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15642.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12167.5, "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": 12775.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13287.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 13479.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13223.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11559.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14847.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16294.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18315.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18250.09, "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": 21117.96, "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": 12167.5, "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": 12167.5, "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": 12289.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20205.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 21752.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 13168.4 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 21294.74 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14339.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12167.5, "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": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12775.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19553.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12532.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12775.88, "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": 13035.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13035.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15298.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13035.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12167.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21752.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12532.53, "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": 32330.0, "minimum": 22474.8884, "maximum": 77016.41, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 36595.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 35900.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28474.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 40309.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 40413.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 49724.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 45263.15, "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": 52375.93, "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": 29973.4, "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": 29973.4, "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": 30273.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 50112.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 77016.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 36789.84 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 75395.01 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35563.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 29973.4, "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": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 31472.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48496.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 30872.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 31472.07, "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": 32330.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32330.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34822.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32330.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29973.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 77016.41 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 30872.6, "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": 38796.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29973.4, "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": 31472.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36074.2 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48933.0, "minimum": 34690.6678, "maximum": 79272.3186, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58720.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45294.8, "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": 47559.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 55681.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 56485.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 55413.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43030.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 62218.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 61166.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 76751.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68506.94, "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": 79272.32, "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": 45294.8, "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": 45294.8, "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": 45747.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75846.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 60859.98 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 53826.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45294.8, "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": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 47559.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73400.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 46653.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 47559.54, "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": 48933.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48933.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70703.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48933.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 46653.64, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2651.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2784.14, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7798.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8188.3, "additional_payer_notes": "105% 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": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24170.0, "minimum": 13016.3696, "maximum": 39156.21, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29004.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "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": 23564.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26437.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 26818.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 26309.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21320.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 29540.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 30213.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 36441.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 33838.7, "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": 39156.21, "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": 22442.8, "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": 22442.8, "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": 22667.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 37464.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 36575.98 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 24170.97 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 35805.96 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26587.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "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": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36255.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 23116.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 23564.94, "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": 24170.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24170.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20554.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24170.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22442.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36575.98 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23116.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOTRANSPLANT PARATHYROID", "code_information": [ { "code": "60512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5784.75, "minimum": 251.65, "maximum": 5694.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5694.57 }, { "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.65 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5420.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5423.4 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6344.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6661.34, "additional_payer_notes": "105% 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": "Breast reduction", "code_information": [ { "code": "19318", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44177.0, "discounted_cash": 7080.0, "minimum": 690.0, "maximum": 35341.6, "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": 1990.0 }, { "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 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": 9070.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6726.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9070.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9523.92 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10619.15 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9070.4 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7080.85, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9523.92 }, { "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": 9523.92 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1113.8 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 9065.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9070.4 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7293.28, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2483.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.79, "additional_payer_notes": "105% 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": "Av fistula revision", "code_information": [ { "code": "36833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21923.0, "discounted_cash": 5933.0, "minimum": 690.0, "maximum": 17538.4, "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": 1990.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 896.66, "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": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 896.66 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3364.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3533.22, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 1942.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2039.87, "additional_payer_notes": "105% 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": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8051.0, "minimum": 4111.46, "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": 9661.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.61, "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": 7945.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7400.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7507.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7364.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7189.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8269.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10064.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10200.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11271.72, "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": 13042.99, "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": 7567.61, "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": 7567.61, "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": 7643.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12479.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14383.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7505.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14080.39 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8856.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.61, "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": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7945.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12076.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7794.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7945.99, "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": 8051.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4111.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8051.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7567.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14383.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7794.64, "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": 23528.0, "discounted_cash": 5933.0, "minimum": 690.0, "maximum": 18822.4, "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": 1990.0 }, { "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 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": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10831.59 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.44 }, { "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": 4639.44 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 835.76 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4415.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4418.51 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7354.98, "additional_payer_notes": "105% 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": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7599.0, "minimum": 4278.62, "maximum": 12311.8542, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9119.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "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": 7508.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6867.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6966.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6834.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6793.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7673.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9499.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9466.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10639.87, "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": 12311.85, "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": 7151.12, "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": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7222.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11779.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 9417.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7023.82 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 9219.14 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8359.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7508.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11399.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7365.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7508.68, "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": 7599.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7599.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7599.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9417.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7365.65, "additional_payer_notes": "103.00% of Medicare 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": 24871.0, "minimum": 16986.76, "maximum": 40292.2998, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29846.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.0, "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": 24244.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 27265.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 27659.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 27134.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21935.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 30466.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 31089.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 37582.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34820.51, "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": 40292.3, "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": 23090.0, "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": 23090.0, "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": 23320.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38551.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 37479.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 28875.7 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 36690.57 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27358.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.0, "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": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 24244.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37307.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 23782.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 24244.5, "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": 24871.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24871.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25077.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24871.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37479.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23782.7, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12893.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13537.88, "additional_payer_notes": "105% 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": "Bronchoscopy/lung bx each", "code_information": [ { "code": "31628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 3975.0, "minimum": 173.9, "maximum": 8877.6, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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": 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 173.9, "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": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.9 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2249.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY OF VAGINA", "code_information": [ { "code": "57100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 982.0, "minimum": 68.3, "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": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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": 4264.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1911.28 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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": 701.18 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.3 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 982.0, "minimum": 68.3, "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": 1178.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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": 4264.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1911.28 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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": 701.18 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.3 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Azithromycin For Susp 200 MG/5ML", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "42806015134", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "methodology": "percent of total billed charges", "standard_charge_percentage": 34.0, "median_amount": 28.66, "10th_percentile": 28.66, "90th_percentile": 28.66, "count": "1 through 10" } ] } ] }, { "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": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "Biopsy/removal lymph nodes - 38500 - OR36038500", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12101.0, "discounted_cash": 4175.0, "minimum": 285.75, "maximum": 9680.8, "payers_information": [ { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider 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": 1411.0 }, { "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 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": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "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": 4190.32 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.75 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3988.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 } ] } ] }, { "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": 34222.0, "minimum": 19109.9108, "maximum": 55439.721, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 41066.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31718.7, "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": 33304.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 38307.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 38861.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 38123.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30132.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42804.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 42777.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 52803.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 47910.87, "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": 55439.72, "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": 31718.7, "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": 31718.7, "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": 32035.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 53044.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37644.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 31718.7, "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": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 33304.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 51333.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 32670.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 33304.64, "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": 34222.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34222.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34775.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 34222.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31718.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 32670.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [ { "code": "31654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3828.8, "minimum": 65.78, "maximum": 3828.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3828.8 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.78 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 } ] }, { "setting": "outpatient", "gross_charge": 3828.8, "minimum": 65.78, "maximum": 3828.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3828.8 }, { "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "methodology": "case rate", "standard_charge_dollar": 488.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.78 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3828.8 } ] } ] }, { "description": "Biopsy/removal lymph nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104.0, "discounted_cash": 4175.0, "minimum": 435.15, "maximum": 10483.2, "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": 1411.0 }, { "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 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": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "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": 4190.32 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 435.15 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3988.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "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": 11941.0, "minimum": 6897.988, "maximum": 19344.9222, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14329.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.5, "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": 11715.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11994.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12167.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11936.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10599.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13402.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14926.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16533.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16717.83, "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": 19344.92, "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": 11157.5, "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": 11157.5, "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": 11269.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18509.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12730.8 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13135.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.5, "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": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11715.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17911.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11492.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11715.38, "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": 11941.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11941.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14790.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11941.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11157.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11492.23, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4407.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4628.01, "additional_payer_notes": "105% 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": "Calcium Chloride Inj 10%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "76329330401", "type": "NDC" }, { "code": "J0618", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 21.0, "10th_percentile": 21.0, "90th_percentile": 21.0, "count": "1 through 10" } ] } ] }, { "description": "BIOPSYREMOVAL LYMPH NODES", "code_information": [ { "code": "38520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27308.7, "discounted_cash": 4175.0, "minimum": 488.0, "maximum": 21846.936, "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": 1411.0 }, { "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 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": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "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": 4190.32 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 507.75, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.75 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3988.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 27308.67, "discounted_cash": 4175.0, "minimum": 488.0, "maximum": 21846.936, "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": 1411.0 }, { "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 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": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3966.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6102.47 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4175.29, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4190.32 }, { "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": 4190.32 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 507.75, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.75 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3988.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3990.78 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4300.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9839.22, "additional_payer_notes": "105% 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": "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": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3581.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3760.65, "additional_payer_notes": "105% 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": "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": 32731.0, "minimum": 22769.9216, "maximum": 68383.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39278.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30343.4, "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": 31860.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36547.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 37075.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 36371.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28826.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 40838.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 40914.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 50377.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 45824.52, "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": 53025.52, "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": 30343.4, "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": 30343.4, "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": 30646.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 50734.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 68383.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 35303.61 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 66944.11 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36004.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 30343.4, "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": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 31860.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49097.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 31253.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 31860.57, "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": 32731.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32731.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32731.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30343.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 68383.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 31253.7, "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": 10214.0, "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": 12256.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.58, "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": 10041.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9954.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10098.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9906.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9085.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11123.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12767.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13721.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14299.78, "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": 16546.89, "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": 9563.58, "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": 9563.58, "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": 9659.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15831.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14022.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9747.24 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 13727.61 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11235.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.58, "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": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10041.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15321.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9850.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10041.76, "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": 10214.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10214.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7719.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10214.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14022.83 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9850.49, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3672.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3856.24, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12037.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12639.08, "additional_payer_notes": "105% 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": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31768.0, "minimum": 22061.0756, "maximum": 83358.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38122.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.4, "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": 30927.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 35410.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 35921.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 35239.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 27981.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39566.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 39710.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 48809.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44475.76, "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": 51464.81, "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": 29454.4, "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": 29454.4, "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": 29748.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49241.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 83358.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 34675.44 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 81603.25 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 34945.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.4, "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": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 30927.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 47652.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 30338.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 30927.12, "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": 31768.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31768.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47140.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 31768.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29454.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83358.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 30338.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHOSCOPY DILATEFX REPR", "code_information": [ { "code": "31630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5421.5, "discounted_cash": 3975.0, "minimum": 196.78, "maximum": 5421.5, "payers_information": [ { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 196.78, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.78 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4582.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": 5421.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5421.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "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": 4770.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "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": 5421.5, "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": 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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": 5421.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5421.5, "discounted_cash": 3975.0, "minimum": 196.78, "maximum": 5421.5, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "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": 5421.5, "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": 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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": 5421.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 196.78, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.78 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4582.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": 5421.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5421.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5779.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6068.11, "additional_payer_notes": "105% 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": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8989.0, "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": 10787.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "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": 8855.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8508.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8631.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8467.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8011.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9507.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11236.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11728.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12585.26, "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": 14562.94, "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": 8433.44, "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": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8517.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13933.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12814.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8415.27 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 12544.79 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9888.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13484.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8686.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8855.11, "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": 8989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5869.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8989.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8433.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12814.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8686.44, "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": 17918.0, "minimum": 11870.9354, "maximum": 29028.4236, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21502.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.6, "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": 17507.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19053.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19329.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 18962.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15839.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21290.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22398.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 26264.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25086.29, "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": 29028.42, "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": 16673.6, "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": 16673.6, "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": 16840.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27774.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 27343.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 17905.39 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 26767.4 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19710.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.6, "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": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17507.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26878.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17173.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 17507.28, "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": 17918.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17918.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17674.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17918.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27343.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17173.81, "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": 7083.0, "discounted_cash": 1898.0, "minimum": 154.45, "maximum": 5666.4, "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": 1411.0 }, { "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 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": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "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": 2363.09 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.45 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2249.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6195.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6505.5, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5652.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5935.4, "additional_payer_notes": "105% 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": "BIOPSY OF PENIS", "code_information": [ { "code": "54100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 1761.0, "minimum": 113.14, "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": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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": 4264.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "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": 2598.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 113.14, "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": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.14 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2473.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 4264.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 1761.0, "minimum": 113.14, "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": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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": 4264.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "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": 2598.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 113.14, "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": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.14 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2473.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 4264.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHOSCOPY WTUMOR EXCISE", "code_information": [ { "code": "31640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5421.5, "discounted_cash": 3975.0, "minimum": 238.48, "maximum": 5421.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "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": 5421.5, "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": 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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": 5421.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 238.48, "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": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.48 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4582.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": 5421.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5421.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "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": 4770.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 } ] }, { "setting": "outpatient", "gross_charge": 5421.5, "discounted_cash": 3975.0, "minimum": 238.48, "maximum": 5421.5, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "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": 5421.5, "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": 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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5421.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5421.5 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": 5421.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 238.48, "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": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.48 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4582.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": 5421.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5421.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6646.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6978.69, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4166.17, "additional_payer_notes": "105% 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 of prostate - 55700 - OR36055700", "code_information": [ { "code": "55700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9936.0, "discounted_cash": 2138.0, "minimum": 488.0, "maximum": 8194.4, "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2031.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1614.79 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2138.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2136.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2202.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 18022.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18924.14, "additional_payer_notes": "105% 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": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18528.0, "minimum": 12319.2326, "maximum": 31920.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22233.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17235.9, "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": 18097.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19773.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20059.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19678.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16374.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22094.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23160.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27255.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25939.28, "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": 30015.46, "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": 17235.9, "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": 17235.9, "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": 17408.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28718.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 19753.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 20015.76 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 19337.28 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20380.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17235.9, "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": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18097.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27792.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17752.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18097.7, "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": 18528.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18528.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31920.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18528.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17235.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19753.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17752.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSY OF VULVAPERINEUM", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17436.8, "discounted_cash": 982.0, "minimum": 60.29, "maximum": 13949.464, "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": 1055.0 }, { "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 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": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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": 701.18 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.29 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 17436.83, "discounted_cash": 982.0, "minimum": 60.29, "maximum": 13949.464, "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": 1055.0 }, { "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 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": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 933.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.17, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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": 701.18 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.29 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41870.0, "minimum": 29493.741, "maximum": 71041.4106, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 50244.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38776.6, "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": 40715.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 47340.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 48023.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 47112.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36837.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 52897.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 52337.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 65253.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 58618.39, "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": 67829.85, "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": 38776.6, "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": 38776.6, "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": 39164.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 64898.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 46905.11 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 46057.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 38776.6, "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": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 40715.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 62805.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 39939.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 40715.43, "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": 41870.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41870.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56538.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 41870.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38776.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 39939.9, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 20788.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21827.45, "additional_payer_notes": "105% 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": "Blepharp upr eyelid xcsv skn", "code_information": [ { "code": "15823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11608.0, "discounted_cash": 2200.0, "minimum": 509.48, "maximum": 9286.4, "payers_information": [ { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2357.12 }, { "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": 2357.12 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 509.48, "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": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.48 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2243.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.88 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 4114.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "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": 2640.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2268.0 }, { "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 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": 2244.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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": 785.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2357.12 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4114.72 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4028.09 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.88 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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": "Imagine Health Network, Inc", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 5150.0 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11496.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12071.17, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2782.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2921.22, "additional_payer_notes": "105% 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": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10010.03, "discounted_cash": 3097.0, "minimum": 140.32, "maximum": 8008.024, "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": 1411.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.32 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 10010.0, "discounted_cash": 3097.0, "minimum": 140.32, "maximum": 8008.024, "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": 1411.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.32 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 21313.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22379.22, "additional_payer_notes": "105% 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": "BRONCHOSCOPYNEEDLE BX EACH", "code_information": [ { "code": "31629", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5040.16, "discounted_cash": 3975.0, "minimum": 184.94, "maximum": 5040.16, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 5040.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5040.16, "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": 5040.16, "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": 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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5040.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "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": 5040.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.94 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2249.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": 5040.16, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2562.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2690.73, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12396.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13015.8, "additional_payer_notes": "105% 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": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29056.0, "minimum": 19319.1434, "maximum": 47070.882, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 34867.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26951.4, "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": 28298.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 32206.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 32672.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 32051.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25603.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 35987.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 36320.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 44394.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 40678.54, "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": 47070.88, "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": 26951.4, "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": 26951.4, "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": 27220.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 45036.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 28287.86 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31961.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 26951.4, "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": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 28298.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43584.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 27759.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 28298.97, "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": 29056.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29056.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32863.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 29056.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26951.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27759.94, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9006.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9456.39, "additional_payer_notes": "105% 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": "Bx/curett of cervix w/scope", "code_information": [ { "code": "57454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11586.0, "discounted_cash": 324.0, "minimum": 136.89, "maximum": 9268.8, "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": 1411.0 }, { "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 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": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 308.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 831.37 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.95, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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": 701.18 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 136.89, "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": 324.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.89 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.7, "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": 18193.0, "minimum": 12072.733, "maximum": 29472.7248, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16926.7, "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": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17773.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27289.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17434.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 17773.04, "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": 18193.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18193.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29275.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18193.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25433.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17434.5, "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": 21831.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16926.7, "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": 17773.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19377.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19657.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19284.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16080.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21652.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22741.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 26710.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 25470.26, "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": 29472.72, "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": 16926.7, "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": 16926.7, "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": 17095.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28199.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25433.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19133.5 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 24898.02 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20012.34, "additional_payer_notes": "110.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 23383.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24553.1, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5663.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5946.75, "additional_payer_notes": "105% 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": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30016.0, "minimum": 18061.837, "maximum": 62350.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 36020.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27838.0, "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": 29229.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 33341.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 33823.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 33181.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26446.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 37255.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 37521.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 45958.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 42023.67, "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": 48627.39, "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": 27838.0, "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": 27838.0, "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": 28116.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 46526.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 61367.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 34344.71 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 60075.75 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33018.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 27838.0, "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": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29229.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 45025.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 28673.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 29229.9, "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": 30016.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30016.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62350.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 30016.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27838.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61367.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28673.14, "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": 4043.25, "minimum": 41.66, "maximum": 4043.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4043.25 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 701.18 }, { "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 667.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 667.79 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12490.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13114.89, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10286.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10800.89, "additional_payer_notes": "105% 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": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15931.0, "minimum": 10408.5414, "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": 19117.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14839.4, "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": 15581.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16706.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16947.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16626.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14097.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18667.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19914.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23028.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22303.69, "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": 25808.56, "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": 14839.4, "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": 14839.4, "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": 14987.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24693.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18182.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15303.98 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 17799.32 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17524.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14839.4, "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": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15581.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23896.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15284.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15581.37, "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": 15931.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15931.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17779.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15931.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14839.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18182.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15284.58, "additional_payer_notes": "103.00% 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": 20364.0, "minimum": 13670.5102, "maximum": 33746.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24437.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18930.7, "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": 19877.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21942.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 22259.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21836.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17984.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24518.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 25455.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 30245.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 28510.45, "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": 32990.67, "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": 18930.7, "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": 18930.7, "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": 19120.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 31565.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 22863.18 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 20643.93 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 22381.85 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22401.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18930.7, "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": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30546.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19498.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19877.24, "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": 20364.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20364.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33746.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20364.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18930.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22863.18 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19498.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7287.0, "minimum": 4048.724, "maximum": 24394.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8744.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.77, "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": 7205.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6498.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6592.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6467.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6519.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7261.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9109.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8957.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10202.43, "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": 11805.67, "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": 6862.77, "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": 6862.77, "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": 6931.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11295.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 24394.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7102.47 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 23880.84 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8016.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.77, "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": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7205.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10931.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7068.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7205.91, "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": 7287.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7287.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8251.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7287.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6862.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24394.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7068.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2884.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3028.6, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 16365.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17183.28, "additional_payer_notes": "105% 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": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5734.0, "minimum": 2906.2686, "maximum": 15425.44, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 6881.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.87, "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": 5701.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 4664.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 4732.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 4642.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 5158.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5212.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 7168.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6430.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 8028.61, "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": 9290.25, "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": 5429.87, "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": 5429.87, "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": 5484.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 8888.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 15425.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 4453.66 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 15100.7 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6308.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.87, "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": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 5701.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8602.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 5592.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 5701.36, "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": 5734.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5734.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5174.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 5734.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5429.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15425.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 5592.77, "additional_payer_notes": "103.00% of Medicare 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": 86693.0, "minimum": 62472.9608, "maximum": 230315.95, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 104031.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 80140.1, "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": 84147.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 100274.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 101723.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 99791.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 76133.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 112046.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 108366.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 138219.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 121370.2, "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": 140442.66, "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": 80140.1, "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": 80140.1, "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": 80941.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 134374.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 230315.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 97312.04 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 225467.19 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 95362.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 80140.1, "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": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 84147.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 130039.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 82544.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 84147.11, "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": 86693.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 86693.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 121121.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 86693.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 80140.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 230315.95 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 82544.3, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2482.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2606.92, "additional_payer_notes": "105% 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": "Bronch ebus samplng 1/2 node", "code_information": [ { "code": "31652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16002.0, "discounted_cash": 3975.0, "minimum": 217.88, "maximum": 12801.6, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4373.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.88 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4582.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2984.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3133.8, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 43458.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 45631.04, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4063.15, "additional_payer_notes": "105% 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": "Bronch ebus samplng 3/> node", "code_information": [ { "code": "31653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18452.0, "discounted_cash": 3975.0, "minimum": 240.78, "maximum": 14761.6, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4373.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4814.61 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.78 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4582.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4585.34 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8170.0, "minimum": 4698.1802, "maximum": 17344.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9804.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.34, "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": 8061.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7541.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7649.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7504.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7293.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8426.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10212.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10394.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11438.2, "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": 13235.63, "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": 7677.34, "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": 7677.34, "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": 7754.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12663.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 17344.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7454.36 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 16979.11 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8987.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.34, "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": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12255.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7907.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8061.21, "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": 8170.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8170.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8170.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17344.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7907.66, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10946.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11494.08, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14202.71, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8391.72, "additional_payer_notes": "105% 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 AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12234.0, "minimum": 6705.9526, "maximum": 31469.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14681.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11428.2, "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": 11999.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12341.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12519.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12281.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10856.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13789.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15293.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17011.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17128.55, "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": 19820.18, "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": 11428.2, "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": 11428.2, "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": 11542.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18963.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 31469.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12159.09 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 30806.95 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13458.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11428.2, "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": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11999.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18352.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11771.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11999.61, "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": 12234.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12234.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10121.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12234.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11428.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31469.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11771.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18646.0, "minimum": 16478.32, "maximum": 30208.0914, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22376.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17345.6, "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": 18212.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 19913.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20201.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 19818.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16478.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22251.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23308.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27449.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26105.76, "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": 30208.09, "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": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22342.2 }, { "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": 17345.6, "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": 17519.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 28902.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 18483.15 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20511.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17345.6, "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": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18212.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27970.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 17865.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18212.88, "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": 18646.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18646.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23751.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18646.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17345.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17865.97, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8362.03, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 56702.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 59537.34, "additional_payer_notes": "105% 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 WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6698.0, "minimum": 3615.1146, "maximum": 11940.54, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8037.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6318.93, "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": 6634.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 5802.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 5886.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 5774.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6002.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6483.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8372.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7998.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 9377.37, "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": 10850.95, "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": 6318.93, "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": 6318.93, "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": 6382.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 10382.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 11940.54 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 5641.44 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 11689.16 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7367.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6318.93, "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": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 6634.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10047.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6508.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 6634.88, "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": 6698.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6698.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4759.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 6698.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6318.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11940.54 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6508.5, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15447.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16219.44, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8270.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8683.75, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4270.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4483.52, "additional_payer_notes": "105% 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 DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 63671.0, "minimum": 45534.7344, "maximum": 103148.5104, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 76406.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 58895.7, "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": 61840.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 73087.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 74142.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 72735.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55950.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 81667.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 79589.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 100744.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 89140.69, "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": 103148.51, "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": 58895.7, "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": 58895.7, "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": 59484.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 98691.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 71256.56 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 70039.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 58895.7, "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": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 61840.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 95507.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 60662.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 61840.49, "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": 63671.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63671.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68721.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 63671.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 58895.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 60662.57, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6484.11, "additional_payer_notes": "105% 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": "Bx of cervix w/scope leep", "code_information": [ { "code": "57460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9261.0, "discounted_cash": 3451.0, "minimum": 163.19, "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": 1411.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4261.79 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.19 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "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": 41989.8658, "maximum": 101202.29, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 70624.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "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": 57172.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 67397.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 68370.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 67072.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51727.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 75309.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 73567.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 92901.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 82395.61, "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": 95343.5, "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": 54449.6, "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": 54449.6, "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": 54994.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 91223.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 101202.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 59986.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 99071.72 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 64739.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "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": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 57172.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 88281.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 56083.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 57172.08, "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": 58854.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58854.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69689.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 58854.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 101202.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 56083.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14120.0, "minimum": 8320.5786, "maximum": 31352.94, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16944.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.7, "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": 13827.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14568.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14778.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14498.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12510.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16278.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17650.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20081.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19768.98, "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": 22875.53, "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": 13168.7, "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": 13168.7, "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": 13300.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21887.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 31352.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 14813.94 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 30692.87 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15532.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.7, "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": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13827.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21181.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13563.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13827.14, "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": 14120.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14120.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13393.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14120.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13168.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31352.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13563.76, "additional_payer_notes": "103.00% of Medicare 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": 45530.0, "minimum": 32186.7172, "maximum": 73759.1832, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42154.2, "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": 44261.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 51662.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 52408.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 51413.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40046.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 57727.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 56912.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 71211.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 63742.5, "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": 73759.18, "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": 42154.2, "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": 42154.2, "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": 42575.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 70572.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 72600.56 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 46307.19 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 71072.13 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50083.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 42154.2, "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": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 44261.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 68295.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 43418.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 44261.91, "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": 45530.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45530.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46047.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 45530.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42154.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 72600.56 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 43418.83, "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": 54636.43, "additional_payer_notes": "120.00% of Medicare 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": 48069.0, "minimum": 34055.2608, "maximum": 94913.59, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 57683.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44497.8, "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": 46722.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 54661.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 55451.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 54398.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42272.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 61078.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 60087.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 75346.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 67297.9, "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": 77873.29, "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": 44497.8, "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": 44497.8, "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": 44942.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 74508.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 94913.59 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 53406.63 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 92915.41 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 52876.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 44497.8, "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": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 46722.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 72104.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 45832.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 46722.69, "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": 48069.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48069.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55313.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48069.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44497.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 94913.59 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 45832.73, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6686.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.68, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 63450.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 66622.98, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 35944.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 37741.33, "additional_payer_notes": "105% 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": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16101.0, "minimum": 8809.0, "maximum": 26084.1384, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19321.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.4, "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": 15746.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16907.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17151.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16826.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14246.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18892.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20126.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23305.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22541.85, "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": 26084.14, "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": 14996.4, "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": 14996.4, "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": 15146.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24957.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16293.12 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17711.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.4, "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": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15746.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24151.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15446.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15746.22, "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": 16101.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16101.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16101.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15446.29, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4319.83, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 53992.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 56692.09, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5152.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5409.83, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6090.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6395.06, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6005.69, "additional_payer_notes": "105% 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": "Care of miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9574.0, "discounted_cash": 3451.0, "minimum": 418.08, "maximum": 7659.2, "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": 2268.0 }, { "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 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": 2171.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2171.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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": 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2280.04 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5315.53 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2171.47 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2280.04 }, { "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": 2280.04 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.08 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2170.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2171.47 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "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": 24285.0, "minimum": 12498.5428, "maximum": 39343.2228, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29143.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22549.4, "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": 23676.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 26573.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 26957.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 26445.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 21421.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 29692.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 30357.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 36628.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34000.32, "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": 39343.22, "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": 22549.4, "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": 22549.4, "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": 22774.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 37643.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 25749.97 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26714.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 22549.4, "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": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 23676.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36428.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 23225.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 23676.87, "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": 24285.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24285.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16456.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24285.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22549.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23225.88, "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": 15341.0, "minimum": 9974.2934, "maximum": 34997.97, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18409.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.8, "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": 15009.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16009.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16240.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 15932.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13580.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17889.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19176.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22067.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21477.41, "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": 24852.44, "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": 14294.8, "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": 14294.8, "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": 14437.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23778.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 34997.97 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16519.99 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 34261.17 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16875.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.8, "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": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15009.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23011.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14723.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15009.54, "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": 15341.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15341.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24328.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15341.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14294.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34997.97 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14723.64, "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": 35379.0, "minimum": 31147.745, "maximum": 57315.3894, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42455.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32787.1, "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": 34426.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 39675.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 40248.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 39484.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31147.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 44332.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 44224.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 54688.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49531.82, "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": 57315.39, "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": 32787.1, "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": 32787.1, "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": 33114.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54838.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 39209.76 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38917.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 32787.1, "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": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34426.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53069.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 33770.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 34426.46, "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": 35379.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35379.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45552.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35379.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32787.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33770.71, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8033.0, "minimum": 4597.92, "maximum": 13014.8694, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9640.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "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": 7929.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7380.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7486.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7344.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7174.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8246.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10042.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10172.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11247.42, "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": 13014.87, "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": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8280.0 }, { "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": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7627.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12452.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 10616.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7193.21 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 10393.3 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8837.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7929.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12050.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7778.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7929.17, "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": 8033.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8033.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6916.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8033.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10616.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.14, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9492.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9966.68, "additional_payer_notes": "105% 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": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8020.0, "discounted_cash": 2082.0, "minimum": 468.29, "maximum": 6416.0, "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": 1411.0 }, { "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 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": 1690.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1690.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1775.34 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5123.14 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1690.8 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1775.34 }, { "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": 1775.34 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.29 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1689.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1690.8 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "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": 32705.0, "minimum": 22750.7636, "maximum": 67118.72, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39246.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30319.4, "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": 31835.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 36517.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 37044.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 36341.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 28803.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 40803.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 40882.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 50335.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 45788.08, "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": 52983.35, "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": 30319.4, "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": 30319.4, "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": 30622.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 50693.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 67118.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 35328.82 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 65705.69 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35976.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 30319.4, "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": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 31835.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49058.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 31228.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 31835.37, "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": 32705.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32705.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41042.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32705.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30319.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 67118.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.98, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7262.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7626.06, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9082.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9536.71, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9432.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9903.83, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5611.06, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11598.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12178.11, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7903.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8298.3, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2880.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3024.23, "additional_payer_notes": "105% 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 CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15461.0, "minimum": 7028.8778, "maximum": 45818.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 18553.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.1, "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": 15126.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16152.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16385.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16074.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13685.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18048.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19327.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22264.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21646.31, "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": 25047.87, "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": 14406.1, "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": 14406.1, "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": 14550.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23965.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 45818.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15098.28 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 44853.91 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17007.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.1, "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": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23192.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14838.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.41, "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": 15461.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15461.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17540.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15461.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45818.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.28, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5873.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6166.76, "additional_payer_notes": "105% 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 CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9710.0, "minimum": 5408.5194, "maximum": 15827.45, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11652.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.03, "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": 9553.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9360.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9495.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9315.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8644.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10459.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12138.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12902.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13595.01, "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": 15731.37, "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": 9099.03, "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": 9099.03, "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": 9190.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15051.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 15827.45 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9340.89 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 15494.24 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10681.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.03, "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": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9553.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14566.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9372.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9553.98, "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": 9710.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9710.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9353.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9710.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15827.45 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9372.0, "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": 9566.0, "discounted_cash": 2229.0, "minimum": 200.25, "maximum": 7652.8, "payers_information": [ { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5898.48 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "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": 2598.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.25 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2473.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10728.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11264.9, "additional_payer_notes": "105% 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": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53918.0, "minimum": 38358.1476, "maximum": 87347.2734, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 64701.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49894.6, "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": 52389.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 61568.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 62457.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 61271.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47399.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 68795.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 67397.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 84866.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 75485.3, "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": 87347.27, "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": 49894.6, "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": 49894.6, "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": 50393.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 83573.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 62458.14 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 59309.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 49894.6, "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": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 52389.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 80877.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 51391.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 52389.33, "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": 53918.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53918.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 53918.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49894.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 51391.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Circumcision w/regionl block", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8913.0, "discounted_cash": 2229.0, "minimum": 95.06, "maximum": 7130.4, "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": 1055.0 }, { "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 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": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5898.48 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "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": 2598.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.06 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2473.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5362.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5630.22, "additional_payer_notes": "105% 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": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19335.0, "minimum": 12913.1306, "maximum": 41515.4864, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23202.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17980.8, "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": 18879.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20726.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21026.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20626.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17081.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23159.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24169.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 28569.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27069.34, "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": 31323.09, "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": 17980.8, "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": 17980.8, "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": 18160.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29969.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 24747.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 17722.89 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 24226.28 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21268.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17980.8, "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": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18879.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29002.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18520.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18879.84, "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": 19335.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19335.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20588.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19335.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17980.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24747.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18520.22, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3947.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4144.78, "additional_payer_notes": "105% 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": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7968.0, "minimum": 4550.025, "maximum": 14495.81, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9562.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.52, "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": 7866.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7303.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7408.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7268.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7116.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8160.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9960.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10066.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11156.29, "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": 12909.42, "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": 7491.52, "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": 7491.52, "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": 7566.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12351.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14495.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7022.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14190.64 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8765.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.52, "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": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7866.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11953.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7716.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7866.1, "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": 7968.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7968.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7015.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7968.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14495.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7716.27, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15826.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16617.89, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9582.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10061.41, "additional_payer_notes": "105% 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": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9343.0, "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": 11212.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.22, "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": 9198.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8926.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9055.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8883.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8322.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9974.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11679.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12304.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13081.03, "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": 15136.62, "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": 8760.22, "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": 8760.22, "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": 8847.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14482.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12007.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8881.11 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 11754.78 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10277.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.22, "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": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14015.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9023.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.23, "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": 9343.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9343.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6027.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9343.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12007.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9023.03, "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": "00703205601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23093.0, "minimum": 8809.0, "maximum": 37411.308, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27712.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21448.9, "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": 22521.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25165.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 25528.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 25043.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20376.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28119.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 28866.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 34687.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32330.76, "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": 37411.31, "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": 21448.9, "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": 21448.9, "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": 21663.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 35794.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 18573.89 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25402.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 21448.9, "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": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22521.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34640.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 22092.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 22521.35, "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": 23093.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23093.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15361.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 23093.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21448.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22092.37, "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": 41989.8658, "maximum": 118143.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 70624.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "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": 57172.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 67397.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 68370.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 67072.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51727.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 75309.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 73567.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 92901.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 82395.61, "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": 95343.5, "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": 54449.6, "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": 54449.6, "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": 54994.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 91223.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 118143.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 65115.01 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 115656.27 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 64739.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "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": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 57172.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 88281.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 56083.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 57172.08, "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": 58854.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58854.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55425.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 58854.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54449.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 118143.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 56083.09, "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": 27354.0, "minimum": 24112.425, "maximum": 44315.019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25381.5, "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": 26650.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 30197.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 30633.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 30052.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 24112.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33742.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 34193.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 41624.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 38296.93, "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": 44315.02, "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": 25381.5, "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": 25381.5, "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": 25635.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 42400.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 33438.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 29212.47 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 32734.54 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 30090.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 25381.5, "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": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 26650.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 41032.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 26142.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 26650.58, "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": 27354.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27354.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29098.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 27354.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25381.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33438.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 26142.95, "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": 32825.94, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10097.0, "minimum": 6116.5108, "maximum": 16358.4684, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12117.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9456.25, "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": 9929.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9817.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9959.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9770.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8983.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10970.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12622.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13532.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14136.95, "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": 16358.47, "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": 9456.25, "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": 9456.25, "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": 9550.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15651.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8807.5 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11107.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9456.25, "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": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9929.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15146.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9739.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9929.06, "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": 10097.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10097.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8041.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10097.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9456.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9739.94, "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": 68427.0, "minimum": 49033.6238, "maximum": 147053.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 82112.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 63284.1, "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": 66448.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 78703.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 79840.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 78324.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 60119.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 87942.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 85534.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 108485.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 95798.26, "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": 110852.27, "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": 63284.1, "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": 63284.1, "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": 63916.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 106062.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 147053.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 78017.21 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 143957.3 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 75270.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 63284.1, "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": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 66448.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 102641.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 65182.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 66448.31, "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": 68427.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68427.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80275.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 68427.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 63284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 147053.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 65182.62, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22973.0, "minimum": 20271.385, "maximum": 37217.2644, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27568.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21338.3, "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": 22405.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25023.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 25385.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 24903.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20271.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 27961.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 28717.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 34492.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32163.07, "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": 37217.26, "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": 21338.3, "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": 21338.3, "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": 21551.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 35609.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 28069.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 23870.49 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 27478.18 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25270.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 21338.3, "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": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22405.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34460.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21978.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 22405.22, "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": 22973.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22973.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24862.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22973.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21338.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28069.11 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21978.45, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6188.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6497.64, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10772.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.62, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 29392.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30861.73, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8623.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9054.58, "additional_payer_notes": "105% 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6985.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7334.89, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 34442.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 36164.6, "additional_payer_notes": "105% 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": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10985.0, "minimum": 6769.7986, "maximum": 17796.8664, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13182.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.6, "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": 10789.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10866.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11023.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10813.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9761.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12141.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13732.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14977.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15380.01, "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": 17796.87, "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": 10275.6, "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": 10275.6, "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": 10378.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17027.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10919.89 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12084.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.6, "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": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10789.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16478.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10583.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10789.38, "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": 10985.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10985.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9691.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10985.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10275.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10583.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 376582.0, "minimum": 275765.3608, "maximum": 610121.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 451899.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 347657.0, "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": 365039.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 442628.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 449021.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 440496.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 330274.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 494589.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 470728.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 610121.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 527216.13, "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": 610064.38, "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": 347657.0, "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": 347657.0, "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": 351133.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 583703.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 380258.16 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 414241.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 347657.0, "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": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 365039.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 564874.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 358086.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 365039.85, "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": 376582.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 376582.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 383311.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 376582.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 347657.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 358086.71, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 25707.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26992.82, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9317.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9783.32, "additional_payer_notes": "105% 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": "Cltx sho dslc w/mnpj w/anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5652.0, "discounted_cash": 1714.0, "minimum": 365.0, "maximum": 4550.0, "payers_information": [ { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 1055.0 }, { "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 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": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1628.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% 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 Systems", "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": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4188.85 }, { "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1714.71, "additional_payer_notes": "100.00% 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 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 Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 1766.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.2 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1211.33 }, { "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" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 28446.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29868.64, "additional_payer_notes": "105% 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": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11477.0, "minimum": 7131.8848, "maximum": 18594.1008, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13773.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10729.8, "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": 11266.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11447.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11612.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11392.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10193.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12791.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14347.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15779.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16068.98, "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": 18594.1, "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": 10729.8, "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": 10729.8, "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": 10837.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17790.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10706.13 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12625.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10729.8, "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": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11266.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17216.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11051.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11266.29, "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": 11477.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11477.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14345.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11477.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11051.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cmplx rpr fccmnaxghf - 13132 - ", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6777.16, "discounted_cash": 433.0, "minimum": 274.72, "maximum": 5421.728, "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": 1620.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.72 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3301.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3466.87, "additional_payer_notes": "105% 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": "Change stent via transureth", "code_information": [ { "code": "50385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.0, "discounted_cash": 2229.0, "minimum": 212.15, "maximum": 5666.4, "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": 1055.0 }, { "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 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": 1838.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1930.64 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1930.64 }, { "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": 1930.64 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 212.15, "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": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.15 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1837.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cmplx rpr sal 2.6-7.5 cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 433.0, "minimum": 235.73, "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": 520.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.73 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5548.5, "discounted_cash": 433.0, "minimum": 235.73, "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": 520.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.73 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22532.0, "minimum": 19884.925, "maximum": 36502.9902, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27039.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20931.5, "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": 21978.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 24502.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 24856.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 24384.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19884.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 27379.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 28165.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 33774.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 31545.79, "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": 36502.99, "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": 20931.5, "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": 20931.5, "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": 21140.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 34925.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 22936.81 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24785.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20931.5, "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": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21978.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33799.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21559.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 21978.08, "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": 22532.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22532.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29011.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 22532.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20931.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21559.45, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 33427.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35098.61, "additional_payer_notes": "105% 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": "Cmplx rpr trunk 1.1-2.5 cm", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8043.16, "discounted_cash": 788.0, "minimum": 187.91, "maximum": 6434.528, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 1541.96 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1509.5 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 187.91, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.91 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 1541.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "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": 19722.0, "minimum": 13197.9462, "maximum": 41408.61, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23666.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18338.0, "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": 19254.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21183.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21489.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21081.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17421.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23670.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24652.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29199.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27611.28, "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": 31950.19, "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": 18338.0, "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": 18338.0, "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": 18521.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30569.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 41408.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19945.18 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 40536.85 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21694.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18338.0, "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": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19254.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29583.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18888.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19254.9, "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": 19722.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19722.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23693.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19722.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18338.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41408.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18888.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAUTERIZATION OF CERVIX", "code_information": [ { "code": "57510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5278.49, "discounted_cash": 3451.0, "minimum": 117.49, "maximum": 5278.49, "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": 1411.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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": 5278.49, "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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5278.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4261.79 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.49 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": 5278.49, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 43482.0, "minimum": 19943.0196, "maximum": 70442.298, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 52179.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40264.8, "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": 42278.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 49244.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 49955.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 49007.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38251.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 55025.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 54353.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 67878.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 60876.06, "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": 70442.3, "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": 40264.8, "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": 40264.8, "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": 40667.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 67398.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 50487.6 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 47831.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 40264.8, "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": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 42278.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 65224.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 41472.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 42278.04, "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": 43482.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43482.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53692.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 43482.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41472.74, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15023.0, "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": 18028.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14001.6, "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": 14701.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 15634.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 15860.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 15559.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13301.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17469.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 18779.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 21550.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21032.69, "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": 24337.83, "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": 14001.6, "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": 14001.6, "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": 14141.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 23286.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18887.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15608.48 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18489.88 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16525.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14001.6, "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": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14701.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22535.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 14421.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 14701.68, "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": 15023.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15023.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13202.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15023.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14001.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18887.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14421.65, "additional_payer_notes": "103.00% of Medicare 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": 13617.0, "minimum": 8706.0338, "maximum": 28948.15, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16340.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.1, "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": 13339.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13973.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14175.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13906.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12068.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15614.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17021.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 19261.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19064.21, "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": 22060.01, "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": 12704.1, "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": 12704.1, "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": 12831.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 21106.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 28948.15 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 13815.73 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 28338.72 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14979.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.1, "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": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13339.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20425.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13085.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13339.31, "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": 13617.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13617.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23976.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13617.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28948.15 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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": 19902.0, "minimum": 13330.1364, "maximum": 32241.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23882.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18503.8, "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": 19428.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21396.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21705.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21293.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17578.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23907.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24877.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29492.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27862.8, "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": 32241.24, "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": 18503.8, "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": 18503.8, "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": 18688.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30848.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 20450.34 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21892.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18503.8, "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": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19428.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29853.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19058.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19428.99, "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": 19902.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19902.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16408.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19902.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18503.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19058.91, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2151.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2259.44, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 21264.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22327.26, "additional_payer_notes": "105% 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": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14316.0, "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": 17180.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13349.7, "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": 14017.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14800.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 15013.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14728.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12682.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16537.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17896.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20400.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 20043.59, "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": 23193.3, "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": 13349.7, "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": 13349.7, "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": 13483.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22191.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 13817.74 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15748.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13349.7, "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": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 14017.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21475.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13750.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 14017.19, "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": 14316.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14316.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10853.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14316.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13750.19, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4745.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4982.47, "additional_payer_notes": "105% 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 WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9101.0, "minimum": 5383.398, "maximum": 21404.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10921.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8536.76, "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": 8963.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8640.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8765.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8599.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8109.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9655.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11376.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11910.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12742.0, "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": 14744.32, "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": 8536.76, "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": 8536.76, "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": 8622.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14107.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 21404.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8662.31 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 20953.63 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10011.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8536.76, "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": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8963.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13652.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8792.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8963.6, "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": 9101.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9101.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8478.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9101.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8536.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21404.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8792.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13139.0, "minimum": 8115.1676, "maximum": 21285.2772, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15766.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.8, "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": 12875.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13409.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 13602.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13344.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11649.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14983.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16423.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18483.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18394.68, "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": 21285.28, "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": 12262.8, "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": 12262.8, "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": 12385.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20365.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12812.47 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14452.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.8, "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": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12875.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19708.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12630.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12875.94, "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": 13139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9536.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12630.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLEX CYSTOMETROGRAM", "code_information": [ { "code": "51726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3647.0, "discounted_cash": 266.0, "minimum": 188.51, "maximum": 3647.0, "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": 1055.0 }, { "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 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": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 253.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% 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": 3647.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 999.14 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 978.11 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "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": 532.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 188.51, "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": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.51 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 999.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 3647.0, "discounted_cash": 266.0, "minimum": 188.51, "maximum": 3647.0, "payers_information": [ { "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.51 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 999.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.42, "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": 319.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 253.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% 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": 3647.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 999.14 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 978.11 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "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": 532.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 188.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11398.0, "minimum": 7073.7722, "maximum": 25815.79, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13678.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.9, "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": 11189.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11354.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11518.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11299.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10124.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12686.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14248.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15650.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15958.39, "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": 18466.14, "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": 10656.9, "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": 10656.9, "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": 10763.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17668.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 25815.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 11323.21 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 25272.3 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12538.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.9, "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": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11189.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17098.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10976.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11189.75, "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": 11398.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11398.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9529.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11398.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25815.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10976.61, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3773.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3962.32, "additional_payer_notes": "105% 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": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18815.0, "minimum": 12530.6092, "maximum": 37288.92, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22578.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17501.0, "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": 18376.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20112.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20403.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20015.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16625.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22473.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23519.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27723.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26341.49, "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": 30480.87, "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": 17501.0, "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": 17501.0, "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": 17676.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29163.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 37288.92 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19402.72 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 36503.89 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20696.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17501.0, "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": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18376.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28223.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18026.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18376.05, "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": 18815.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18815.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15797.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18815.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17501.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37288.92 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18026.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4938.82, "additional_payer_notes": "105% 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": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7759.0, "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": 9311.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "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": 7663.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7056.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7158.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7022.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6933.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7884.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9699.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9726.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10863.45, "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": 12570.57, "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": 7298.49, "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": 7298.49, "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": 7371.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12027.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12306.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6934.08 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 12047.4 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8535.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7663.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11639.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7517.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7663.41, "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": 7759.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7759.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6343.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7759.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12306.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7517.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin HCl Ophth Oint 0.3%", "drug_information": { "unit": 4.0, "type": "GR" }, "code_information": [ { "code": "00078084101", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43694.0, "minimum": 38437.19, "maximum": 91574.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 52433.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40460.2, "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": 42483.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 49494.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 50209.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 49256.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38437.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 55305.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 54618.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 68223.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 61172.55, "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": 70785.38, "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": 40460.2, "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": 40460.2, "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": 40864.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 67726.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 91574.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 48976.16 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 89646.78 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 48064.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 40460.2, "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": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 42483.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 65542.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 41674.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 42483.21, "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": 43694.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43694.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46488.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 43694.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40460.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91574.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41674.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11319.0, "minimum": 7015.6596, "maximum": 18456.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13583.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10584.0, "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": 11113.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11260.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11423.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11206.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10054.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12582.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14149.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15521.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15847.82, "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": 18338.19, "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": 10584.0, "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": 10584.0, "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": 10689.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17545.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18456.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10809.98 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18067.81 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12451.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10584.0, "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": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11113.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16979.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10901.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11113.2, "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": 11319.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11319.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16053.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11319.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10584.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18456.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10901.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11072.0, "minimum": 6833.6586, "maximum": 34539.2306, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13287.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10355.7, "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": 10873.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10968.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11127.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10915.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9837.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12256.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13840.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15119.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15501.51, "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": 17937.47, "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": 10355.7, "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": 10355.7, "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": 10459.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17162.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 29366.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10987.45 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 28748.51 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12179.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10355.7, "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": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16608.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10666.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10873.49, "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": 11072.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12791.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11072.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10355.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29366.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10666.37, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6918.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7264.77, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5303.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5569.16, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5464.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5738.07, "additional_payer_notes": "105% 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": "Cholecystectomy w/cholang", "code_information": [ { "code": "47605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20751.0, "minimum": 1268.78, "maximum": 16600.8, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6808.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6808.58 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7149.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6808.58 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7149.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7149.01 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1268.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1268.78 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6804.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6808.58 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4037.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4239.07, "additional_payer_notes": "105% 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": "Cltx sho dslc w/mnpj wo anes", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448.0, "discounted_cash": 263.0, "minimum": 139.0, "maximum": 4550.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 289.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 577.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "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": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.49 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 270.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.18, "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": 405.14, "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": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 405.14 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 577.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 577.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 581.56, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 328.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 494.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.92, "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": 315.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 276.18, "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": 577.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 249.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 355.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 577.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 368.24, "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": 426.11, "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": 263.03, "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": 365.0 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "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": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 407.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.49 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 494.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.03, "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": 302.48, "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": 263.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 483.81 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 21059.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22112.15, "additional_payer_notes": "105% 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": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20033.0, "minimum": 13426.565, "maximum": 47953.49, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24039.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18624.7, "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": 19555.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21550.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21862.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21447.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17693.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24080.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 25041.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29705.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 28046.28, "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": 32453.56, "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": 18624.7, "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": 18624.7, "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": 18810.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 31051.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 47953.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 21492.92 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 46943.94 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22036.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18624.7, "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": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19555.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30049.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19183.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19555.94, "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": 20033.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20033.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24969.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20033.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18624.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47953.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19183.44, "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": 11795.0, "minimum": 7365.6124, "maximum": 29247.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14154.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.9, "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": 11574.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11822.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11993.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11765.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10471.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13210.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14744.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16296.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16513.7, "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": 19108.71, "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": 11022.9, "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": 11022.9, "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": 11133.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18283.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 29247.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 11673.09 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 28631.63 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12975.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.9, "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": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11574.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17693.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11353.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11574.05, "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": 11795.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11795.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13263.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11795.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29247.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11353.59, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cmplx rpr fccmnaxghf - 13131 - ", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3767.0, "discounted_cash": 433.0, "minimum": 223.87, "maximum": 3767.0, "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": 1411.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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": 3767.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 223.87, "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": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.87 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 3767.0, "discounted_cash": 433.0, "minimum": 223.87, "maximum": 3767.0, "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": 1411.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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": 3767.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 223.87, "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": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.87 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10106.0, "minimum": 6122.8968, "maximum": 16372.53, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12127.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9464.26, "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": 9937.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9827.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9969.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9780.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8991.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10981.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12633.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13546.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14149.1, "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": 16372.53, "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": 9464.26, "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": 9464.26, "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": 9558.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15665.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9122.09 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11117.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9464.26, "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": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9937.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15159.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9748.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9937.47, "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": 10106.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10106.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10484.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10106.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9464.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9748.19, "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": 16196.0, "minimum": 10603.953, "maximum": 37755.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19436.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15084.5, "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": 15838.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17020.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17266.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16938.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14330.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19018.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20245.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23460.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22675.51, "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": 26238.8, "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": 15084.5, "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": 15084.5, "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": 15235.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25105.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 37755.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16762.99 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 36960.39 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17816.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15084.5, "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": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15838.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24295.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15537.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15838.73, "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": 16196.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16196.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19474.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16196.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15084.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37755.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15537.04, "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": 9042.0, "minimum": 5339.9732, "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": 10850.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "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": 8906.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8571.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8694.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8529.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8058.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9577.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11303.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11814.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12659.37, "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": 14648.7, "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": 8482.29, "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": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14015.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 15063.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7523.93 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14746.39 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9946.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8906.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13563.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8736.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8906.4, "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": 9042.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8527.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9042.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8482.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15063.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8736.76, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11115.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11671.31, "additional_payer_notes": "105% 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": "Change of bladder tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 266.0, "minimum": 52.56, "maximum": 7272.0, "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": 1055.0 }, { "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 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": 108.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 253.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.63 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 676.96 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 266.43, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.63 }, { "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": 113.63 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.56 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 108.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.42, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12098.67, "additional_payer_notes": "105% 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": "Cor hlx vlgs double osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111.0, "discounted_cash": 7737.0, "minimum": 615.58, "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": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2268.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 615.58 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": 15111.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "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": 18452.0, "discounted_cash": 1276.0, "minimum": 246.84, "maximum": 14761.6, "payers_information": [ { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "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": 1531.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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 Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1212.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% 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 Systems", "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 Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 2516.69 }, { "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% 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 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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.84 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1236.83 }, { "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" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3719.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3905.57, "additional_payer_notes": "105% 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": "CHROMOTUBATION OF OVIDUCT,INC MATERIALS", "code_information": [ { "code": "58350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21614.0, "discounted_cash": 5334.0, "minimum": 92.08, "maximum": 17291.2, "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": 1620.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 21614.0, "discounted_cash": 5334.0, "minimum": 92.08, "maximum": 17291.2, "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": 1620.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.08 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 36466.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 38290.03, "additional_payer_notes": "105% 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": "COLPOPEXY EXTRAPERITONEAL", "code_information": [ { "code": "57282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26803.0, "discounted_cash": 7907.0, "minimum": 699.65, "maximum": 21442.4, "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": 2268.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.65 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 26803.0, "discounted_cash": 7907.0, "minimum": 699.65, "maximum": 21442.4, "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": 2268.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.65 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "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": 9156.0, "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": 10988.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8588.02, "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": 9017.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8706.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8832.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8664.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8158.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9728.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11446.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12001.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12819.77, "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": 14834.31, "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": 8588.02, "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": 8588.02, "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": 8673.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14193.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8256.97 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10072.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8588.02, "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": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13735.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8845.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9017.42, "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": 9156.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7691.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9156.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8588.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8845.66, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2588.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2718.23, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 49374.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 51843.63, "additional_payer_notes": "105% 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": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11188.0, "minimum": 6919.231, "maximum": 22639.79, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13426.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.0, "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": 10986.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11105.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11266.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11052.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9939.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12409.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13986.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15308.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15664.33, "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": 18125.87, "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": 10463.0, "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": 10463.0, "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": 10567.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17342.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 22639.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10981.4 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 22163.16 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12307.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.0, "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": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10986.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16783.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10776.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10986.15, "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": 11188.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11188.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10595.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11188.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10463.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22639.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10776.89, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3190.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3349.88, "additional_payer_notes": "105% 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5825.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6117.0, "additional_payer_notes": "105% 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": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 68140.0, "minimum": 48822.2472, "maximum": 140454.65, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 81768.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 63019.0, "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": 66169.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 78364.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 79495.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 77986.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 59868.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 87563.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 85175.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 108017.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 95396.06, "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": 110386.86, "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": 63019.0, "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": 63019.0, "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": 63649.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 105617.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 140454.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 78812.76 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 137497.71 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 74954.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 63019.0, "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": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 66169.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 102210.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 64909.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 66169.95, "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": 68140.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68140.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 82814.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 68140.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 63019.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 140454.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 64909.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 96164.0, "minimum": 69442.0026, "maximum": 155786.9112, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 115397.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 88880.9, "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": 93324.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 111460.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 113070.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 110923.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 84436.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 124545.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 120205.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 153637.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 134630.66, "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": 155786.91, "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": 88880.9, "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": 88880.9, "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": 89769.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 149055.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 105781.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 88880.9, "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": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 93324.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 144247.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 91547.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 93324.95, "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": 96164.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 96164.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 127609.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 96164.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 88880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 91547.33, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10203.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10714.01, "additional_payer_notes": "105% 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": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54404.0, "minimum": 38715.7636, "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": 65284.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50343.1, "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": 52860.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 62142.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 63039.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 61843.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47825.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 69437.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 68005.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 85657.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 76165.77, "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": 88134.67, "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": 50343.1, "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": 50343.1, "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": 50846.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 84326.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 61594.02 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 59844.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 50343.1, "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": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 52860.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 81606.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 51853.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 52860.26, "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": 54404.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54404.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71556.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 54404.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 50343.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 51853.39, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7811.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8202.26, "additional_payer_notes": "105% 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": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30455.0, "minimum": 21094.8738, "maximum": 61277.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 36546.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28242.5, "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": 29654.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 33859.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 34348.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 33696.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26830.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 37834.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 38069.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 46671.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 42637.29, "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": 49337.44, "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": 28242.5, "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": 28242.5, "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": 28524.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 47205.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 61277.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 27591.12 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 59987.35 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33500.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 28242.5, "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": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29654.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 45682.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 29089.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 29654.63, "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": 30455.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30455.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32053.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 30455.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61277.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29089.78, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3578.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3757.15, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 44507.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 46732.38, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 17032.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17883.9, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7165.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7523.47, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4406.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4627.14, "additional_payer_notes": "105% 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": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10731.0, "minimum": 6582.6888, "maximum": 17384.8842, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12877.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10040.9, "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": 10542.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10565.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10718.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10514.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9538.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11806.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13414.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14563.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15023.97, "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": 17384.88, "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": 10040.9, "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": 10040.9, "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": 10141.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16633.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14611.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10510.52 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14304.07 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11804.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10040.9, "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": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10542.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16097.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10342.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10542.95, "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": 10731.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10731.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9888.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10731.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10040.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14611.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10342.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Contour of face bone lesion", "code_information": [ { "code": "21029", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.0, "discounted_cash": 3535.0, "minimum": 488.0, "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": 4242.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3358.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7083.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 7083.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3535.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3447.29 }, { "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": 3447.29 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 632.73, "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": 3535.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 632.73 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3281.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3283.13 }, { "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": 7083.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 7083.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3641.55, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3525.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3701.71, "additional_payer_notes": "105% 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": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7356.0, "minimum": 4099.812, "maximum": 14718.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8828.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "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": 7273.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6580.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6675.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6548.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6580.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7353.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9196.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9070.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10299.65, "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": 11918.16, "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": 6926.85, "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": 6926.85, "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": 6996.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11403.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14718.2 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6525.72 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14408.34 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8092.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11035.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7134.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.19, "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": 7356.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5283.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7356.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6926.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14718.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7134.66, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 26198.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 27508.36, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3684.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3868.46, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5357.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5625.47, "additional_payer_notes": "105% 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": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20990.0, "minimum": 10223.7354, "maximum": 50672.33, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 25188.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19508.2, "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": 20483.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 22681.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 23009.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 22572.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 18532.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25344.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 26237.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 31264.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 29386.55, "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": 34004.43, "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": 19508.2, "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": 19508.2, "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": 19703.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 32535.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 50672.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 22316.7 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 49605.54 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23089.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 19508.2, "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": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 20483.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31485.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 20093.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 20483.61, "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": 20990.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20990.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20990.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50672.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20093.45, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6438.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6760.43, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11276.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11840.68, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 14276.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14990.63, "additional_payer_notes": "105% 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": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10951.0, "minimum": 6744.8932, "maximum": 21778.03, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13142.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10244.4, "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": 10756.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10826.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10982.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10774.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9732.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12097.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13689.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14922.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15332.62, "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": 17742.03, "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": 10244.4, "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": 10244.4, "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": 10346.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16975.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 21778.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10786.79 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 21319.54 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12047.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10244.4, "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": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10756.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16427.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10551.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10756.62, "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": 10951.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10951.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10951.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10244.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21778.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10551.73, "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": 14710.0, "discounted_cash": 3489.0, "minimum": 488.0, "maximum": 11768.0, "payers_information": [ { "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": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 496.32 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 1411.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18867.0, "minimum": 12568.9252, "maximum": 32588.34, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22640.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17549.0, "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": 18426.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20174.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20465.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20077.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16671.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22542.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23584.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27808.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26414.4, "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": 30565.24, "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": 17549.0, "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": 17549.0, "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": 17724.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29244.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 32588.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19753.61 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 31902.27 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20754.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17549.0, "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": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18426.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28301.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18075.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18426.45, "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": 18867.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18867.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20905.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18867.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17549.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32588.34 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18075.47, "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": 74950.0, "minimum": 53833.3414, "maximum": 121420.1664, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 89940.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 69304.0, "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": 72769.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 86407.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 87655.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 85991.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 65838.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 96551.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 93688.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 119104.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 104931.01, "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": 121420.17, "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": 69304.0, "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": 69304.0, "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": 69997.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 116173.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 85442.33 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 82445.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 69304.0, "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": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 72769.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 112426.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 71383.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 72769.2, "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": 74950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 74950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62519.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 74950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 69304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 71383.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CLOSURE OF VAGINA", "code_information": [ { "code": "57120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9051.0, "discounted_cash": 5334.0, "minimum": 533.84, "maximum": 9051.0, "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": 2268.0 }, { "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 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": 6957.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6957.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7305.43 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6957.55 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7305.43 }, { "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": 7305.43 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.84 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6953.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6957.55 }, { "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": 9051.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 9051.0, "discounted_cash": 5334.0, "minimum": 533.84, "maximum": 9051.0, "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": 2268.0 }, { "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 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": 6957.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6957.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7305.43 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6957.55 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7305.43 }, { "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": 7305.43 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 533.84 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6953.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6957.55 }, { "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": 9051.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10000.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10500.12, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 22928.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24074.67, "additional_payer_notes": "105% 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": "Cmplx rpr fccmnaxghf - 13133 - ", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5511.2, "minimum": 114.49, "maximum": 4550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.49 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 } ] }, { "setting": "outpatient", "gross_charge": 5511.2, "minimum": 114.49, "maximum": 4550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.49 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 } ] } ] }, { "description": "CMBN ANT PST COLPRHY", "code_information": [ { "code": "57260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24812.45, "discounted_cash": 5334.0, "minimum": 785.0, "maximum": 19849.96, "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": 2268.0 }, { "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 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": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Systems", "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": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 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 Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.19 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 13287.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13952.14, "additional_payer_notes": "105% 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": "Corrj halux rigdus w/o implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 3489.0, "minimum": 477.73, "maximum": 8877.6, "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": 1620.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.62 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 477.73 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4881.64, "additional_payer_notes": "105% 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": "Cmplx rpr sal 1.1-2.5 cm", "code_information": [ { "code": "13120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8043.12, "discounted_cash": 433.0, "minimum": 215.98, "maximum": 6434.496, "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": 1411.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 426.01 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 215.98, "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": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.98 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "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": 8445.0, "discounted_cash": 2229.0, "minimum": 132.82, "maximum": 6756.0, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.82 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28770.0, "minimum": 25353.505, "maximum": 71214.69, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 34524.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26687.9, "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": 28022.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 31869.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 32329.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 31716.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25353.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 35610.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 35963.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 43929.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 40278.77, "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": 46608.29, "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": 26687.9, "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": 26687.9, "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": 26954.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 44594.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 71214.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 30839.86 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 69715.43 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31647.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 26687.9, "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": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 28022.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43155.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 27488.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 28022.3, "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": 28770.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28770.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29972.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28770.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26687.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 71214.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27488.54, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7998.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8398.7, "additional_payer_notes": "105% 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": "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": "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" }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6191.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6501.14, "additional_payer_notes": "105% 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" } ] } ] }, { "description": "Cystoscopy & revise urethra", "code_information": [ { "code": "52275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8202.0, "discounted_cash": 2229.0, "minimum": 245.5, "maximum": 6561.6, "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": 1411.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 245.5, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.5 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23681.0, "minimum": 20892.305, "maximum": 46662.48, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 28418.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21991.9, "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": 23091.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25859.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 26233.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 25735.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20892.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28895.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 29602.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 35645.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 33154.6, "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": 38364.61, "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": 21991.9, "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": 21991.9, "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": 22211.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 36706.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 46662.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 24882.83 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 45680.11 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26050.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 21991.9, "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": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 23091.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35522.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 22651.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 23091.5, "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": 23681.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23681.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29923.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 23681.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46662.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22651.66, "additional_payer_notes": "103.00% 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2607.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.31, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15236.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15998.56, "additional_payer_notes": "105% 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": "Cystoscopy and treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13322.0, "discounted_cash": 3758.0, "minimum": 285.44, "maximum": 10657.6, "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": 1620.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.44 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60206.0, "minimum": 35951.702, "maximum": 120099.54, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 72247.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55697.5, "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": 58482.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 68994.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 69990.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 68662.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 52912.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 77093.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 75257.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 95102.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 84288.76, "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": 97534.14, "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": 55697.5, "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": 55697.5, "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": 56254.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 93319.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 120099.54 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 68849.75 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 117571.13 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 66226.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 55697.5, "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": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 58482.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 90309.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 57368.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 58482.38, "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": 60206.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60206.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 105635.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 60206.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 55697.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 120099.54 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 57368.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8733.0, "minimum": 5112.6316, "maximum": 18935.89, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10480.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.16, "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": 8607.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8206.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8324.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8166.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7787.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9169.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10916.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11311.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12226.8, "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": 14148.16, "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": 8197.16, "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": 8197.16, "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": 8279.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13536.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18935.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7555.19 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18537.24 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9606.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.16, "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": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8607.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13100.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8443.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8607.02, "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": 8733.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8733.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6256.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8733.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8197.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18935.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8443.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy and treatment - 52240 - OR36052240", "code_information": [ { "code": "52240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21719.0, "discounted_cash": 5717.0, "minimum": 387.51, "maximum": 17375.2, "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": 1620.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 387.51 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 43968.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 46166.65, "additional_payer_notes": "105% 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": "COLPOPEXY INTRAPERITONEAL", "code_information": [ { "code": "57283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31272.2, "discounted_cash": 7907.0, "minimum": 706.79, "maximum": 25017.792, "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": 2268.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.79 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 31272.24, "discounted_cash": 7907.0, "minimum": 706.79, "maximum": 25017.792, "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": 2268.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7512.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 12338.58 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7907.57, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.79 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8144.8, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13517.0, "minimum": 8632.5948, "maximum": 48719.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 16220.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12612.0, "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": 13242.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13856.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14056.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13789.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11981.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15482.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16896.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 19099.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18924.47, "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": 21898.32, "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": 12612.0, "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": 12612.0, "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": 12738.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20952.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 48719.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 14224.09 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 47693.47 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14869.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12612.0, "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": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13242.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20276.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12990.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13242.6, "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": 13517.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13517.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16525.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13517.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12612.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48719.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12990.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy and treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8641.0, "discounted_cash": 2229.0, "minimum": 150.97, "maximum": 6912.8, "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": 1411.0 }, { "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 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": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1864.2 }, { "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 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 Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.97 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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": 51519.0, "minimum": 36593.6958, "maximum": 124205.42, "payers_information": [ { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 83462.35, "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": 47681.6, "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": 47681.6, "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": 48158.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 79855.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 124205.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 57524.52 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 121590.57 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 56671.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 47681.6, "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": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 50065.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 77279.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 49112.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 50065.68, "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": 51519.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51519.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 51519.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 124205.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 49112.05, "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": 61823.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47681.6, "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": 50065.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 58736.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 59584.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 58453.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45297.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 65631.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 64399.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 47681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 80962.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 72127.96, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10484.0, "minimum": 6400.6878, "maximum": 18737.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12580.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.67, "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": 10303.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10273.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10422.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10224.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9322.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11479.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13105.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14161.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14677.67, "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": 16984.16, "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": 9812.67, "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": 9812.67, "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": 9910.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16250.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18737.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10243.32 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18342.79 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11532.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.67, "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": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15726.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10107.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.3, "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": 10484.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10484.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8715.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10484.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9812.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18737.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10107.05, "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": 8866.0, "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": 1411.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.44 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURETERO WSTONE REMOVE", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7470.58, "discounted_cash": 3758.0, "minimum": 350.25, "maximum": 7470.58, "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": 1990.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.25 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": 7470.58, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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 : 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5205.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5465.26, "additional_payer_notes": "105% 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": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17674.0, "minimum": 9575.9742, "maximum": 34836.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 21209.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.5, "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": 17270.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 18765.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 19036.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 18675.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15626.08, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20968.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 22093.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 25867.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 24744.85, "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": 28633.32, "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": 16448.5, "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": 16448.5, "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": 16612.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 27396.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 34836.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 18387.36 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 34103.34 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19442.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.5, "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": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 17270.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26512.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16941.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 17270.93, "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": 17674.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17674.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15047.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17674.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34836.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16941.96, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8614.78, "additional_payer_notes": "105% 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": "Dbrdmt bone each addl", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4264.0, "minimum": 100.8, "maximum": 4264.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.8 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1274.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 } ] }, { "setting": "outpatient", "gross_charge": 4264.0, "minimum": 100.8, "maximum": 4264.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4264.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.8 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1274.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12956.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13604.23, "additional_payer_notes": "105% 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": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8929.0, "minimum": 5256.9552, "maximum": 14465.9196, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10715.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.17, "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": 8797.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8437.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8559.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8397.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7959.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9428.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11161.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11630.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12501.41, "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": 14465.92, "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": 8378.17, "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": 8378.17, "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": 8461.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13840.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12356.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8644.16 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 12096.13 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9822.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.17, "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": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8797.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13394.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8629.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8797.08, "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": 8929.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8929.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13151.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8929.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8378.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12356.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8629.52, "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": 23324.0, "minimum": 11019.5836, "maximum": 69409.11, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 27989.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21661.9, "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": 22745.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 25437.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 25805.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 25315.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 20578.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28423.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 29155.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 35063.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 32653.98, "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": 37785.32, "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": 21661.9, "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": 21661.9, "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": 21878.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 36152.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 69409.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 25478.73 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 67947.86 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25656.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 21661.9, "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": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 22745.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34986.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 22311.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 22745.0, "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": 23324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25579.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 23324.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21661.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69409.11 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22311.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt subq tis 1st 20sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7153.0, "discounted_cash": 433.0, "minimum": 61.73, "maximum": 5722.4, "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": 1411.0 }, { "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 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": 479.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.37 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 767.73 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.4 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.37 }, { "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": 503.37 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.73 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 479.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.4 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cysto w/ureter stricture tx", "code_information": [ { "code": "52341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.0, "discounted_cash": 3758.0, "minimum": 280.55, "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": 1620.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.55 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3559.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3737.08, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6727.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7064.25, "additional_payer_notes": "105% 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": "Dbrdmt subq tiss each addl", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5548.5, "minimum": 25.2, "maximum": 4550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1274.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 } ] }, { "setting": "outpatient", "gross_charge": 5548.5, "minimum": 25.2, "maximum": 4550.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1274.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 } ] } ] }, { "description": "Cystoscopy and treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15031.0, "discounted_cash": 3758.0, "minimum": 242.72, "maximum": 12024.8, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.72 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12911.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13556.66, "additional_payer_notes": "105% 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": "CONZ OF CERVIX WSCOPE LEEP", "code_information": [ { "code": "57461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988.0, "discounted_cash": 3451.0, "minimum": 188.54, "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": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.54 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": 6988.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6988.0, "discounted_cash": 3451.0, "minimum": 188.54, "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": 4142.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.54 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": 6988.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "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": 4348.0254, "maximum": 10168.31, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 10168.31 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7963.55 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 9954.24 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9251.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10168.31 } ] } ] }, { "description": "Cystoscopy and treatment - 52260 - OR36052260", "code_information": [ { "code": "52260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15170.0, "discounted_cash": 2229.0, "minimum": 208.87, "maximum": 12136.0, "payers_information": [ { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.87 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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" } ] } ] }, { "description": "Conization of cervix - 57520 - OR36057520", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9338.0, "discounted_cash": 3451.0, "minimum": 309.23, "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": 1411.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.23 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18371.0, "discounted_cash": 3489.0, "minimum": 522.6, "maximum": 14696.8, "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": 1620.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 522.6 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 31860.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33453.8, "additional_payer_notes": "105% 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": "Cystoscopy and treatment - 52276 - OR36052276", "code_information": [ { "code": "52276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7967.0, "discounted_cash": 2229.0, "minimum": 261.68, "maximum": 6373.6, "payers_information": [ { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.68 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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": 2674.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5375.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5644.67, "additional_payer_notes": "105% 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": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49197.0, "minimum": 34884.8022, "maximum": 91046.09, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59036.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45538.3, "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": 47815.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 55993.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 56801.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 55723.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43261.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 62566.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 61496.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 77181.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68876.33, "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": 79699.76, "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": 45538.3, "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": 45538.3, "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": 45993.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 76255.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 91046.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 53643.58 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 89129.33 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 54117.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45538.3, "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": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 47815.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73796.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 46904.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 47815.22, "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": 49197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67924.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49197.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45538.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91046.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 46904.45, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7507.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7882.73, "additional_payer_notes": "105% 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 - 52281 - OR36052281", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8077.0, "discounted_cash": 2229.0, "minimum": 152.98, "maximum": 6461.6, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.98 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4617.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4848.46, "additional_payer_notes": "105% 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 WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52720.0, "minimum": 37476.8796, "maximum": 122261.96, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 63264.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48789.3, "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": 51228.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 60153.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 61022.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 59864.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46349.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 67215.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 65900.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 82916.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 73808.45, "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": 85406.92, "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": 48789.3, "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": 48789.3, "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": 49277.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 81716.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 122261.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 59330.39 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 119688.02 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 57992.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48789.3, "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": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51228.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 79080.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 50252.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 51228.77, "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": 52720.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52720.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63818.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 52720.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48789.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 122261.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50252.98, "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": 7934.0, "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": 9520.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.48, "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": 7832.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7262.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7367.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7227.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7086.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8114.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9917.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10010.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11107.68, "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": 12853.18, "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": 7459.48, "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": 7459.48, "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": 7534.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12297.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 10890.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6650.75 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 10661.25 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8727.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.48, "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": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7832.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11901.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7683.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7832.45, "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": 7934.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7934.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7934.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10890.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7683.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY AND TREATMENT - 52320 - ", "code_information": [ { "code": "52320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4368.0, "discounted_cash": 3758.0, "minimum": 242.82, "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": 4368.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2268.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "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": 4368.0, "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": 3758.92, "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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 4368.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.82 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": 4368.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 4368.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4368.0, "discounted_cash": 3758.0, "minimum": 242.82, "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": 4368.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2268.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "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": 4368.0, "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": 3758.92, "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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4368.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 4368.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.82 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": 4368.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4368.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 4368.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs jt arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14919.8, "discounted_cash": 13690.0, "minimum": 558.0, "maximum": 14919.82, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "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": 14919.82, "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", "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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8278.05 }, { "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": 14919.82, "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": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% 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": "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 14919.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.47 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": 14919.82, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 14919.82, "discounted_cash": 13690.0, "minimum": 558.0, "maximum": 14919.82, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13006.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "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": 14919.82, "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", "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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8278.05 }, { "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": 14919.82, "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": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8103.78 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "additional_payer_notes": "100.00% 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": "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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 14919.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 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": 13690.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 613.47 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": 14919.82, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14919.82, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13690.75, "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14101.47, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 25530.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26806.87, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2595.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2725.21, "additional_payer_notes": "105% 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": "Cystoscopy and treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10669.0, "discounted_cash": 3758.0, "minimum": 156.01, "maximum": 8535.2, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.01 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "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": 6875.4, "discounted_cash": 7737.0, "minimum": 528.89, "maximum": 6875.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "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": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6875.4 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 6875.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 6875.4 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6875.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6875.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.89 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6875.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6875.4, "discounted_cash": 7737.0, "minimum": 528.89, "maximum": 6875.4, "payers_information": [ { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6875.4 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 6875.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 6875.4 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6875.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6875.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.89 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6875.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6875.4, "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": 6875.4, "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": 6875.4, "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": 6875.4, "additional_payer_notes": "100.00% 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": 39343.0, "minimum": 27634.7764, "maximum": 63736.8426, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 47212.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36445.1, "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": 38267.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 44356.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 44996.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 44142.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34622.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 49563.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 49179.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 61140.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 55081.22, "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": 63736.84, "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": 36445.1, "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": 36445.1, "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": 36809.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 60982.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 42947.53 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 43278.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36445.1, "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": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38267.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 59015.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 37538.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 38267.36, "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": 39343.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39343.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55814.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 39343.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36445.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37538.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323050601", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 3.85, "count": "1 through 10" } ] } ] }, { "description": "CYSTOSCOPY IMPLANT STENT", "code_information": [ { "code": "52282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7250.0, "discounted_cash": 3758.0, "minimum": 335.46, "maximum": 7250.0, "payers_information": [ { "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.46 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": 7250.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 7250.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider 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": 1620.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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": 1467.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7250.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 7250.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 335.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 7250.0, "discounted_cash": 3758.0, "minimum": 335.46, "maximum": 7250.0, "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": 1620.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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": 1467.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 7250.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 7250.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 335.46, "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": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.46 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": 7250.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 7250.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 24906.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26152.08, "additional_payer_notes": "105% 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": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29133.0, "minimum": 20122.286, "maximum": 63654.1862, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 34960.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "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": 28373.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 32298.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 32764.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 32142.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25671.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 36089.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 36416.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 44519.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 40786.69, "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": 47196.03, "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": 27022.7, "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": 27022.7, "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": 27292.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 45156.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 32216.19 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32046.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "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": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 28373.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43700.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 27833.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 28373.84, "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": 29133.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29133.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42072.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 29133.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27833.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy w/biopsy(s)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8349.0, "discounted_cash": 2229.0, "minimum": 142.38, "maximum": 6679.2, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.38 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 30329.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31846.08, "additional_payer_notes": "105% 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": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29648.0, "minimum": 20501.6144, "maximum": 48031.218, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 35578.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27498.5, "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": 28873.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 32906.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 33382.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 32748.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26123.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 36770.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 37061.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 45359.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 41508.46, "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": 48031.22, "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": 27498.5, "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": 27498.5, "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": 27773.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 45955.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 28858.55 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32613.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 27498.5, "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": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 28873.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 44473.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 28323.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 28873.43, "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": 29648.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29648.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33525.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 29648.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28323.46, "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": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "CYSTOURETERO STRICTURE TX", "code_information": [ { "code": "52344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6672.0, "discounted_cash": 3758.0, "minimum": 365.09, "maximum": 6672.0, "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": 1620.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 6672.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6672.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.09 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": 6672.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 6672.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6672.0, "discounted_cash": 3758.0, "minimum": 365.09, "maximum": 6672.0, "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": 1620.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 6672.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6672.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.09 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": 6672.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 6672.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "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": 38140.0, "minimum": 26749.6768, "maximum": 69756.89, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 45768.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35334.9, "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": 37101.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 42935.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 43555.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 42728.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33568.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 47976.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 47675.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 59182.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 53397.08, "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": 61788.05, "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": 35334.9, "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": 35334.9, "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": 35688.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 59118.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 69756.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 41462.3 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 68288.32 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 41954.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35334.9, "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": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37101.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 57211.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 36394.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 37101.65, "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": 38140.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38140.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51578.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 38140.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69756.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36394.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystourethro w/implant", "code_information": [ { "code": "52441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14688.0, "minimum": 205.9, "maximum": 11750.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2244.72 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.9 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2136.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2137.83 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 30317.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31833.86, "additional_payer_notes": "105% 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": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41247.0, "minimum": 36291.425, "maximum": 125792.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 49496.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.5, "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": 40111.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 46604.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 47277.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 46379.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36291.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 52075.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 51558.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 64239.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 57745.95, "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": 66820.32, "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": 38201.5, "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": 38201.5, "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": 38583.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 63933.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 125792.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 45094.2 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 123144.48 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 45371.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.5, "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": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 40111.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 61870.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 39347.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 40111.58, "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": 41247.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41247.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45086.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 41247.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 125792.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 39347.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 10%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338002304", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "CYSTOURETHRO WADDL IMPLANT", "code_information": [ { "code": "52442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4038.4, "minimum": 49.98, "maximum": 4038.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4038.4 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.98 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 } ] }, { "setting": "outpatient", "gross_charge": 4038.4, "minimum": 49.98, "maximum": 4038.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4038.4 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.98 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4038.4 } ] } ] }, { "description": "Corrj halux rigdus w/implt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15227.0, "discounted_cash": 7737.0, "minimum": 476.65, "maximum": 15227.0, "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": 1620.0 }, { "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 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": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7185.27 }, { "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": 7185.27 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.65 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6839.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6843.11 }, { "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": 15227.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 23270.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24433.93, "additional_payer_notes": "105% 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": "Dantrolene Sodium For IV Soln 20 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "78670000367", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15709.0, "minimum": 10245.0598, "maximum": 40297.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 21992.63, "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": 25448.61, "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": 14634.4, "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": 14634.4, "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": 14780.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24348.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 40297.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 15584.28 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 39448.91 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17279.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.4, "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": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15366.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23563.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15073.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15366.12, "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": 15709.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15709.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15880.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15709.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40297.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15073.43, "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": 18850.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.4, "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": 15366.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16444.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16681.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16365.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 13902.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18374.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19636.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14634.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 22666.83 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10758.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11296.34, "additional_payer_notes": "105% 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": "Dbrdmt musc&/fsca 1st 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10068.0, "discounted_cash": 788.0, "minimum": 157.24, "maximum": 8054.4, "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": 1411.0 }, { "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 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": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.37 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 767.73 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.4 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.37 }, { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 503.37 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.24 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 479.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 479.4 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 20342.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21359.5, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7444.46, "additional_payer_notes": "105% 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": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7176.0, "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": 8611.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.25, "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": 7098.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6367.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6459.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6336.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6422.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7114.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8970.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8776.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10046.9, "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": 11625.7, "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": 6760.25, "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": 6760.25, "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": 6827.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11123.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 10617.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6318.01 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 10393.55 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7894.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.25, "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": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7098.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10764.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6963.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7098.26, "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": 7176.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7176.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4839.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7176.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10617.07 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6963.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6057.236, "maximum": 23461.86, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 23461.86 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12381.92 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 22967.92 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14384.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23461.86 } ] } ] }, { "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": 35737.0, "minimum": 24981.3934, "maximum": 85859.27, "payers_information": [ { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 55393.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 85859.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 38332.54 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 84051.71 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 39311.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33117.1, "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": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34772.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53606.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 34110.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 34772.96, "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": 35737.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35737.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41137.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35737.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 85859.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34110.61, "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": 42884.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33117.1, "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": 34772.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 40097.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 40676.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 39904.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31461.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 44804.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 44671.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 55270.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50032.44, "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": 57894.69, "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": 33117.1, "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": 33117.1, "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": 33448.27, "additional_payer_notes": "101.00% 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 17248.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18110.89, "additional_payer_notes": "105% 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": "Diagnostic anoscopy spx", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 141.0, "minimum": 44.1, "maximum": 7272.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "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": 488.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 134.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "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": 229.83, "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": 141.87, "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 HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "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": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "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": 163.15, "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": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "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": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.94 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 512.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "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": 44.1, "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": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.1 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 253.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 313.67, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 177.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 25958.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 27256.92, "additional_payer_notes": "105% 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" }, { "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" } ] } ] }, { "description": "Create eardrum opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8198.75, "discounted_cash": 1654.0, "minimum": 157.54, "maximum": 6559.0, "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": 1620.0 }, { "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 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": 1756.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1571.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4714.64 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1654.55, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1844.38 }, { "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": 1844.38 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.54 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1755.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1756.55 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1704.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cysto impl 4 or more", "code_information": [ { "code": "C9740", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7119.0, "discounted_cash": 10094.0, "minimum": 1423.8, "maximum": 7119.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2268.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 5526.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5526.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5802.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5526.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5802.6 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5802.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "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": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5523.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5526.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 7119.0, "discounted_cash": 10094.0, "minimum": 1423.8, "maximum": 7119.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2268.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 5526.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5526.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5802.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5526.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5802.6 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5802.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 7119.0, "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": 7119.0, "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": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5523.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5526.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7119.0, "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": 13029.0, "minimum": 8273.7016, "maximum": 21108.114, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15635.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.9, "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": 12770.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13280.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 13471.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 13216.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11553.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14839.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16287.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18305.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 18241.58, "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": 21108.11, "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": 12161.9, "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": 12161.9, "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": 12283.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 20196.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 17963.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 13454.76 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 17584.93 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14332.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.9, "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": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12770.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19544.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12526.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12770.0, "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": 13029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17051.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 13029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17963.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12526.76, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8618.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9049.12, "additional_payer_notes": "105% 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": "CYSTO RX BALO CATH URTL STRX", "code_information": [ { "code": "52284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12572.0, "discounted_cash": 5717.0, "minimum": 163.7, "maximum": 12572.0, "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": 1620.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6289.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 163.7, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.7 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": 12572.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12572.0, "discounted_cash": 5717.0, "minimum": 163.7, "maximum": 12572.0, "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": 1620.0 }, { "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 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": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6289.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3777.66 }, { "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": 3777.66 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 163.7, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.7 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3595.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.77 }, { "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": 12572.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3582.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3761.52, "additional_payer_notes": "105% 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": "Cystometrogram w/vp", "code_information": [ { "code": "51728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8980.0, "discounted_cash": 743.0, "minimum": 234.49, "maximum": 7184.0, "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": 1055.0 }, { "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 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": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 706.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 817.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "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": 532.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 234.49, "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": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.49 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 765.88, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4479.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4703.97, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2883.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3027.72, "additional_payer_notes": "105% 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": "Cystoscopy and treatment - 52214 - OR36052214", "code_information": [ { "code": "52214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6997.0, "discounted_cash": 3758.0, "minimum": 171.49, "maximum": 6997.0, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 6997.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.49 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": 6997.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 6997.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4467.37, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9674.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10157.89, "additional_payer_notes": "105% 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": "Cystoscopy chemodenervation", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448.0, "discounted_cash": 2229.0, "minimum": 168.45, "maximum": 4928.5622, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.45 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5619.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5900.04, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9975.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10474.37, "additional_payer_notes": "105% 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": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4424.0, "discounted_cash": 3758.0, "minimum": 283.76, "maximum": 4424.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 4424.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "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": 4424.0, "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": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4424.0 }, { "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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1864.2 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 4424.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.76 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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" } ] }, { "setting": "outpatient", "gross_charge": 4424.0, "discounted_cash": 3758.0, "minimum": 283.76, "maximum": 4424.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "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": 4424.0, "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": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4424.0 }, { "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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1864.2 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 4424.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.76 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": 4424.0, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4424.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 13507.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14182.62, "additional_payer_notes": "105% 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": "Destruction penis lesion(s)", "code_information": [ { "code": "54065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.0, "discounted_cash": 2200.0, "minimum": 162.32, "maximum": 6822.4, "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": 1055.0 }, { "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 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": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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": 365.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2598.68 }, { "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": 2598.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 162.32, "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": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.32 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2473.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2474.93 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/uretero w/lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18376.0, "discounted_cash": 5717.0, "minimum": 411.37, "maximum": 14700.8, "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": 1990.0 }, { "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 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": 5091.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5091.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5346.11 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6289.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5091.53 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5346.11 }, { "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": 5346.11 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 411.37 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5088.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5091.53 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy stone removal", "code_information": [ { "code": "52325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11926.0, "discounted_cash": 5717.0, "minimum": 316.99, "maximum": 11926.0, "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": 1990.0 }, { "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 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": 5091.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5091.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5346.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5091.53 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5346.11 }, { "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": 5346.11 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 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": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.99 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5088.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5091.53 }, { "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": 11926.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15429.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16201.11, "additional_payer_notes": "105% 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": "Dexamethasone Sodium Phosphate Inj 10 MG/ML - 00641036725", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641036725", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 3.85, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy and treatment - 52224 - OR36052224", "code_information": [ { "code": "52224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16166.0, "discounted_cash": 3758.0, "minimum": 197.94, "maximum": 12932.8, "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": 1411.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 6850.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.94 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero & or pyeloscope", "code_information": [ { "code": "52351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097.0, "discounted_cash": 3758.0, "minimum": 298.84, "maximum": 8877.6, "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": 1620.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5517.82 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.84 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15933.0, "minimum": 10410.4572, "maximum": 52027.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19120.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14841.8, "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": 15583.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16709.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 16951.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16629.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14099.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18671.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 19917.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23032.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22307.33, "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": 25812.77, "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": 14841.8, "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": 14841.8, "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": 14990.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24697.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 52027.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16775.09 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 50931.79 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17527.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14841.8, "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": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15583.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23900.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15287.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15583.89, "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": 15933.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15933.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17228.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 15933.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14841.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52027.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15287.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 MG/ML - 67457042300 - 25000001", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "67457042300", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 3.85, "count": "1 through 10" } ] } ] }, { "description": "Cystouretero w/lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25846.0, "discounted_cash": 5717.0, "minimum": 385.97, "maximum": 20676.8, "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": 1990.0 }, { "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 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": 3635.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5431.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3635.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3817.34 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 10024.23 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3635.56 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.65, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3817.34 }, { "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": 3817.34 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.97 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3633.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3635.56 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5889.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7343.0, "discounted_cash": 743.0, "minimum": 80.22, "maximum": 5874.4, "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": 1055.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 706.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1864.2 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.22 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 765.88, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2738.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2874.94, "additional_payer_notes": "105% 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": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19569.0, "minimum": 10867.675, "maximum": 31702.7358, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 23483.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18197.0, "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": 19106.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21003.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 21306.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20902.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17287.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23469.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 24461.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 28951.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 27397.43, "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": 31702.74, "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": 18197.0, "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": 18197.0, "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": 18378.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 30332.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 21907.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19702.18 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 21445.93 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21526.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18197.0, "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": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19106.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29354.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18742.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19106.85, "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": 19569.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19569.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16087.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 19569.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18197.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21907.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18742.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 4590.56, "maximum": 22170.6073, "payers_information": [ { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17301.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11222.47, "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": 13989.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "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": 11440.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11659.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11827.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11603.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10350.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13028.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14571.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 16071.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 16320.5, "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": 18885.15, "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": 10895.6, "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": 10895.6, "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": 11004.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 18069.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 17301.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10333.06 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 16937.41 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12823.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "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": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11440.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17486.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11222.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11440.38, "additional_payer_notes": "105.00% 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4555.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4782.98, "additional_payer_notes": "105% 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": "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": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "Dextrose 5% w/ Sodium Chloride 0.2%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338007704", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 3.17, "10th_percentile": 3.17, "90th_percentile": 3.17, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5501.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5776.94, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 22906.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24051.97, "additional_payer_notes": "105% 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": "Dbrdmt bone 1st 20 sq cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12011.0, "discounted_cash": 1761.0, "minimum": 229.92, "maximum": 9608.8, "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": 1411.0 }, { "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 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": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1975.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "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": 1339.11 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.92 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1274.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 18777.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19716.86, "additional_payer_notes": "105% 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": "Diag laparo separate proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17227.0, "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": 1620.0 }, { "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 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": 4590.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6124.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% 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 Systems", "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": "Community Health Patners", "plan_name": "Community Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6368.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 9220.01 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6446.75, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4819.63 }, { "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": 4819.63 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 371.22 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4587.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6640.15, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 43695.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 45880.3, "additional_payer_notes": "105% 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": "Dbrdmt musc&fsca ea addl", "code_information": [ { "code": "11046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3494.0, "minimum": 56.26, "maximum": 3494.0, "payers_information": [ { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.26 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1274.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3494.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 3494.0, "minimum": 56.26, "maximum": 3494.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3494.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1339.11 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.26 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1274.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1275.34 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 27783.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29172.38, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5518.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5793.96, "additional_payer_notes": "105% 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": "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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5579.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5858.57, "additional_payer_notes": "105% 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" }, { "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" } ] } ] }, { "description": "Decompression of lower leg", "code_information": [ { "code": "27600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17952.0, "discounted_cash": 3489.0, "minimum": 430.6, "maximum": 14361.6, "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": 1620.0 }, { "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 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": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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": 4124.79 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 430.6, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 430.6 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3926.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 17952.0, "discounted_cash": 3489.0, "minimum": 430.6, "maximum": 14361.6, "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": 1620.0 }, { "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 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": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5990.14 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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": 4124.79 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 430.6, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 430.6 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3926.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 33370.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35038.82, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7901.06, "additional_payer_notes": "105% 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": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21947.0, "minimum": 14835.3166, "maximum": 48672.94, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 26337.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20391.6, "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": 21411.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 23812.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 24155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 23697.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 19372.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26607.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 27434.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 32822.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 30726.81, "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": 35555.31, "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": 20391.6, "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": 20391.6, "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": 20595.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 34018.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 48672.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 25248.84 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 47648.24 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24142.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 20391.6, "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": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 21411.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32921.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 21003.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 21411.18, "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": 21947.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21947.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25534.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 21947.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20391.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48672.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21003.35, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4395.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4615.79, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 60660.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 63693.48, "additional_payer_notes": "105% 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": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9681.0, "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": 11617.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9071.79, "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": 9525.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9325.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9460.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9280.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8618.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10420.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12101.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12854.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13553.69, "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": 15683.56, "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": 9071.79, "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": 9071.79, "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": 9162.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15005.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 13428.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9484.07 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 13145.89 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10649.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9071.79, "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": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9525.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14521.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9343.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9525.38, "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": 9681.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9681.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8660.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9681.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9071.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13428.6 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9343.94, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 13367.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14035.52, "additional_payer_notes": "105% 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": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5993.0, "discounted_cash": 327.0, "minimum": 45.6, "maximum": 4794.4, "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": 1055.0 }, { "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 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": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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 Systems", "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": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 649.03 }, { "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": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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 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 Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.6 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 308.96 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 9544.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10022.12, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10069.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10573.46, "additional_payer_notes": "105% 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": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16685.0, "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": 20022.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.5, "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": 16312.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17597.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17851.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17512.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14758.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19663.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20856.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 24256.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 23359.62, "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": 27030.41, "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": 15535.5, "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": 15535.5, "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": 15690.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25862.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 28860.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16510.91 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 28253.25 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18353.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.5, "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": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16312.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25028.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16001.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 16312.28, "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": 16685.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16685.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17056.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16685.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28860.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448.0, "discounted_cash": 327.0, "minimum": 56.46, "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": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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 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 Systems", "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": "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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 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 Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 56.46, "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": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.46 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 575.83 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 16789.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17628.98, "additional_payer_notes": "105% 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": "Destroy vulva lesions sim", "code_information": [ { "code": "56501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13595.0, "discounted_cash": 2200.0, "minimum": 131.38, "maximum": 10876.0, "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": 1055.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5113.81 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5006.15 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 131.38, "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": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.38 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5113.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5753.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6041.04, "additional_payer_notes": "105% 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": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12820.0, "minimum": 8119.799, "maximum": 23681.12, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 15384.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11968.8, "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": 12567.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 13033.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 13221.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12970.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 11370.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14563.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 16025.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17964.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17948.74, "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": 20769.26, "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": 11968.8, "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": 11968.8, "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": 12088.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19871.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 23681.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 12551.32 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 23182.57 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14102.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11968.8, "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": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12567.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19230.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 12327.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12567.24, "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": 12820.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12820.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12835.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12820.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11968.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23681.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12327.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Destruct b9 lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6700.0, "discounted_cash": 213.0, "minimum": 65.83, "maximum": 5360.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 203.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% 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", "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": 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.7 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 235.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.33 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.7 }, { "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": 217.7 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 65.83, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.83 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 207.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.33 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "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": 256.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 207.33 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2262.94, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4698.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4933.14, "additional_payer_notes": "105% 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": "Destruction anal lesion(s)", "code_information": [ { "code": "46924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6745.0, "discounted_cash": 2959.0, "minimum": 191.59, "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": 1055.0 }, { "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 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": 1806.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2811.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5989.08 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.87, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.35 }, { "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": 1896.35 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 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": 2959.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.59 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1805.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1806.05 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5989.08 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3048.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4574.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4803.06, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12676.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13310.45, "additional_payer_notes": "105% 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": "Dise eval slp do brth flx dx", "code_information": [ { "code": "42975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.0, "discounted_cash": 1898.0, "minimum": 93.07, "maximum": 5666.4, "payers_information": [ { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "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": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1411.0 }, { "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 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": 212.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 223.38 }, { "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.74 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% 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": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 223.38 }, { "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": 223.38 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 93.07, "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": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.07 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 212.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.74 }, { "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" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9951.0, "minimum": 4676.0, "maximum": 16120.8468, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11941.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.89, "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": 9786.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9644.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9783.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9597.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8854.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10776.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12438.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13293.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13931.6, "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": 16120.85, "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": 9320.89, "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": 9320.89, "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": 9414.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15424.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8517.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9216.87 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 8337.81 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10946.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.89, "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": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9786.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14926.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9600.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9786.93, "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": 9951.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9951.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4841.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9951.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9320.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8517.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9600.52, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10014.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10515.39, "additional_payer_notes": "105% 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 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6967.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7316.13, "additional_payer_notes": "105% 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": "DESTROY VAG LESIONS COMPLEX", "code_information": [ { "code": "57065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10402.0, "discounted_cash": 3451.0, "minimum": 186.39, "maximum": 8321.6, "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": 1055.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.39 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 10402.0, "discounted_cash": 3451.0, "minimum": 186.39, "maximum": 8321.6, "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": 1055.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.39 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 23369.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24537.82, "additional_payer_notes": "105% 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": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9085.0, "minimum": 5371.9032, "maximum": 24371.27, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10902.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8522.34, "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": 8948.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8622.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8746.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8580.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8096.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9634.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11357.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11885.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12720.13, "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": 14719.01, "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": 8522.34, "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": 8522.34, "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": 8607.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14083.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 24371.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8673.4 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 23858.19 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9994.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8522.34, "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": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8948.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13628.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8778.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8948.46, "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": 9085.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9085.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8042.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9085.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8522.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24371.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8778.01, "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": 9090.0, "discounted_cash": 2200.0, "minimum": 213.18, "maximum": 7272.0, "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": 1620.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5862.99 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.18 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 10569.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11098.15, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 1943.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.31, "additional_payer_notes": "105% 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": "Dextrose 5% w/ Sodium Chloride 0.45%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338008504", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 3.17, "10th_percentile": 3.17, "90th_percentile": 3.17, "count": "1 through 10" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 10 MG/ML - 00641036721", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641036721", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 0.77, "10th_percentile": 0.77, "90th_percentile": 3.85, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 15031.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15782.92, "additional_payer_notes": "105% 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 WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11283.0, "minimum": 6988.8384, "maximum": 20699.73, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 13540.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.4, "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": 11077.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 11217.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 11379.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 11163.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10022.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12534.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 14104.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15462.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 15796.79, "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": 18279.14, "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": 10550.4, "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": 10550.4, "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": 10655.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 17489.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 20699.73 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10935.01 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 20263.95 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12411.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.4, "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": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 11077.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16925.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10866.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 11077.92, "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": 11283.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11283.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9270.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 11283.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20699.73 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10866.91, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3721.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3907.31, "additional_payer_notes": "105% 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": "ELECTROMYOGRAPHY STUDIES ANALURETHRAL", "code_information": [ { "code": "51784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3030.0, "discounted_cash": 137.0, "minimum": 29.97, "maximum": 3030.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 164.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 144.06, "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": 166.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 130.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 185.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 192.08, "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": 222.26, "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": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3030.0 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 212.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.79 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 319.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "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": 157.78, "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": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 312.5 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 150.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 141.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.06, "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": 29.97, "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": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.97 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 166.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 303.35, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 319.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 3030.0, "discounted_cash": 137.0, "minimum": 29.97, "maximum": 3030.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 164.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 144.06, "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": 166.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 130.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 185.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 192.08, "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": 222.26, "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": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3030.0 }, { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 212.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.79 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 319.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "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": 157.78, "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": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 312.5 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 150.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 141.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.06, "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": 29.97, "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": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.97 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 166.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 303.35, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 319.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16287.0, "minimum": 10670.3674, "maximum": 30886.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19544.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.8, "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": 15926.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 17126.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17374.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 17044.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14409.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19137.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20358.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23607.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22801.88, "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": 26385.04, "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": 15167.8, "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": 15167.8, "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": 15319.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 25244.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 30886.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16983.81 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 30236.55 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17915.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.8, "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": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15926.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24430.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15622.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15926.19, "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": 16287.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16287.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16287.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30886.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15622.83, "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": 9563.0, "minimum": 5723.1332, "maximum": 15865.91, "payers_information": [ { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14344.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9231.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.0, "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": 9563.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6683.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9563.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.75, "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": 11475.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "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": 9411.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9186.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9318.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9141.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8514.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10264.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11953.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12662.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13388.44, "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": 15492.34, "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": 8962.86, "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": 8962.86, "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": 9052.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 14822.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9248.13 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 15531.89 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10519.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8962.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Enalaprilat IV Soln 1.25 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143978601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3486.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3661.12, "additional_payer_notes": "105% 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": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14254.0, "minimum": 8562.2948, "maximum": 29250.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 17105.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13292.0, "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": 13956.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 14726.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 14939.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 14655.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 12627.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16455.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 17817.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 20298.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 19956.1, "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": 23092.06, "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": 13292.0, "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": 13292.0, "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": 13424.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 22094.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 29250.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 14683.87 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 28635.04 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15679.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 13292.0, "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": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 13956.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21381.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 13690.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 13956.6, "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": 14254.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11285.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 14254.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13292.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29250.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13690.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10681.0, "minimum": 6545.65, "maximum": 18482.22, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12817.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "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": 10494.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 10506.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10658.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 10455.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9494.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11739.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 13351.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14482.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14953.5, "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": 17303.33, "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": 9994.49, "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": 9994.49, "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": 10094.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 16555.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18482.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 10419.77 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18093.12 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11749.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 10494.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16021.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 10294.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 10494.21, "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": 10681.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10681.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8662.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10681.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9994.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18482.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10294.32, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6887.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7231.88, "additional_payer_notes": "105% 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": "Diagnostic anoscopy & biopsy", "code_information": [ { "code": "46607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5803.0, "discounted_cash": 1276.0, "minimum": 126.86, "maximum": 4642.4, "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": 1055.0 }, { "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 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": 1237.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1212.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% 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": 690.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1299.43 }, { "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1403.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.55 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1299.43 }, { "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": 1299.43 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 126.86, "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": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.86 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1236.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.55 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1276.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1314.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 50%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409751766", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "description": "ENDOMETR ABLATE THERMAL", "code_information": [ { "code": "58353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13595.0, "discounted_cash": 5334.0, "minimum": 231.28, "maximum": 11794.4468, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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": 1090.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 231.28, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.28 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "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": 6401.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3148.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13595.0, "discounted_cash": 5334.0, "minimum": 231.28, "maximum": 11794.4468, "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": 3148.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5067.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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": 1090.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8182.6 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5334.44, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 231.28, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.28 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5494.47, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 12369.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12987.86, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2895.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3040.38, "additional_payer_notes": "105% 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 BL WCATH INSERTION", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6022.0, "discounted_cash": 2229.0, "minimum": 140.95, "maximum": 4928.5622, "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": 1055.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.95 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6022.0, "discounted_cash": 2229.0, "minimum": 140.95, "maximum": 4928.5622, "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": 1055.0 }, { "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 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": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2117.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2452.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2229.11, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2053.07 }, { "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": 2053.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.95 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1954.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.3 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2295.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9807.0, "minimum": 5902.5798, "maximum": 18920.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 11768.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9187.93, "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": 9647.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9474.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 9611.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9428.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 8728.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10586.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12258.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13059.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 13729.88, "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": 15887.44, "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": 9187.93, "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": 9187.93, "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": 9279.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15200.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 18920.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8903.29 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 18521.93 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10787.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9187.93, "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": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9647.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14710.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9463.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9647.33, "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": 9807.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9807.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9374.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 9807.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9187.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18920.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9463.57, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Drainage abdom abscess open", "code_information": [ { "code": "49020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4816.0, "minimum": 963.2, "maximum": 4816.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4816.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4816.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4816.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1770.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1770.36 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4587.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4590.12 } ] } ] }, { "description": "DILAT XST TRC NDURLGC PX", "code_information": [ { "code": "50436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26770.0, "discounted_cash": 3758.0, "minimum": 152.22, "maximum": 21416.0, "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": 1055.0 }, { "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 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": 1838.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1930.64 }, { "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1930.64 }, { "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": 1930.64 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 152.22, "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": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.22 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1837.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 26770.0, "discounted_cash": 3758.0, "minimum": 152.22, "maximum": 21416.0, "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": 1055.0 }, { "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 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": 1838.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3570.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1930.64 }, { "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4134.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1930.64 }, { "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": 1930.64 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 152.22, "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": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.22 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1837.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1838.7 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3758.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3871.69, "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": "43598072511", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 21.9, "median_amount": 139.77, "10th_percentile": 139.77, "90th_percentile": 154.55, "count": "1 through 10" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4285.34, "additional_payer_notes": "105% 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": "Dilate urethra stricture", "code_information": [ { "code": "53620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7984.0, "discounted_cash": 743.0, "minimum": 86.26, "maximum": 6387.2, "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": 1055.0 }, { "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 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": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 706.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 5326.55 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5214.41 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.57, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "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": 532.07 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 86.26, "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": 743.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.26 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 5326.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 765.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20162.0, "minimum": 7180.7864, "maximum": 37512.29, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24194.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18744.1, "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": 19681.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21703.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 22017.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21599.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17806.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24251.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 25202.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29916.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 28227.33, "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": 32663.06, "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": 18744.1, "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": 18744.1, "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": 18931.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 31251.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 37512.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 23131.41 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 36722.56 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22178.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18744.1, "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": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30243.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19306.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.31, "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": 20162.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20162.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15042.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20162.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18744.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37512.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19306.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dilation and curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8957.0, "discounted_cash": 3451.0, "minimum": 239.05, "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": 1411.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5094.46 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.05 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4774.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5013.03, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4162.24, "additional_payer_notes": "105% 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": "Diphenhydramine HCl Inj 50 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "72485010101", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.8, "median_amount": 15.8, "10th_percentile": 15.8, "90th_percentile": 15.8, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12283.0, "minimum": 7724.5056, "maximum": 26310.35, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 14739.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.0, "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": 12046.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 12398.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 12577.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 12338.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 10899.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13854.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 15354.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17090.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 17196.59, "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": 19898.91, "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": 11473.0, "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": 11473.0, "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": 11587.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 19039.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 26310.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 25756.44 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13511.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.0, "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": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 12046.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18424.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 11817.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 12046.65, "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": 12283.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12283.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12110.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 12283.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26310.35 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11817.19, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6203.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6513.36, "additional_payer_notes": "105% 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": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20347.0, "minimum": 13657.7382, "maximum": 47504.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 24416.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.7, "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": 19860.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 21921.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 22238.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 21816.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 17968.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24495.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 25434.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 30217.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 28486.15, "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": 32962.55, "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": 18914.7, "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": 18914.7, "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": 19103.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 31538.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 47504.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 46504.36 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22381.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.7, "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": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 19860.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30520.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 19482.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 19860.44, "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": 20347.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20347.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22929.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 20347.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47504.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19482.14, "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": 8551.0, "minimum": 4978.5256, "maximum": 13852.8792, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10261.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "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": 8430.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7990.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8106.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7952.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7627.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8929.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10688.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11014.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11971.62, "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": 13852.88, "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": 8028.96, "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": 8028.96, "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": 8109.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13254.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12623.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7867.76 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 12358.07 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9406.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8430.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12826.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8269.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8430.41, "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": 8551.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8551.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6805.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8551.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8028.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12623.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8269.83, "additional_payer_notes": "103.00% of Medicare 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": 186005.0, "minimum": 135544.1272, "maximum": 384358.03, "payers_information": [ { "payer_name": "Cigna HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "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": 173505.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 288308.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 384358.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 376266.28 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 204606.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "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": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 180377.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 279008.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 176941.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 180377.4, "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": 186005.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 186005.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 272842.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 186005.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 384358.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 176941.64, "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": 223206.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 171788.0, "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": 180377.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 217560.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 220702.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 216512.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 163198.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 243100.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 232506.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 171788.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 299886.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 260407.67, "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": 301328.88, "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": 171788.0, "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 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7782.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8171.71, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 5686.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 5971.19, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 14724.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15461.2, "additional_payer_notes": "105% 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": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10162.0, "minimum": 6164.4058, "maximum": 20917.62, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 12195.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.32, "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": 9992.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 9894.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 10037.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 9846.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 9040.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11055.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 12703.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 13638.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 14228.09, "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": 16463.93, "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": 9516.32, "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": 9516.32, "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": 9611.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 15752.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 20917.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 9742.19 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 20477.25 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11179.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.32, "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": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 9992.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15244.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 9801.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 9992.14, "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": 10162.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10162.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9841.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 10162.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20917.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9801.81, "additional_payer_notes": "103.00% of Medicare 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": 7272.0, "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": 1620.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.64 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 19698.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20683.32, "additional_payer_notes": "105% 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 LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17361.0, "minimum": 11460.9542, "maximum": 43684.08, "payers_information": [ { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 16159.4, "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": 16159.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 16967.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26042.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 16644.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 16967.37, "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": 17361.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17361.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19085.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16159.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 17361.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16159.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43684.08 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16644.18, "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": 20833.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16159.4, "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": 16967.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 18395.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 18661.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 18307.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 15351.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20555.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 21701.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 16159.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16159.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 25356.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 24306.18, "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": 28125.73, "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": 16159.4, "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": 16159.4, "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": 16320.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 26910.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 43684.08 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16159.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 19060.9 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 42764.41 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19097.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16159.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 16159.4, "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": 11311.0, "discounted_cash": 3097.0, "minimum": 751.92, "maximum": 9048.8, "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": 1620.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.92 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [ { "code": "51741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9798.67, "discounted_cash": 230.0, "minimum": 7.14, "maximum": 7838.936, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 276.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "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": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 218.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 310.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "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": 373.01, "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": 230.25, "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 HealthSpring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "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": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 356.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "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": 264.79, "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": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 253.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "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": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 345.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "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": 7.14, "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": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.14 }, { "payer_name": "Self Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 287.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.16, "additional_payer_notes": "103.00% of Medicare 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": 7857.0, "minimum": 4468.2842, "maximum": 14426.39, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 9429.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.0, "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": 7758.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7171.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7275.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7137.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7019.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8013.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9885.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11000.75, "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": 12729.44, "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": 7389.0, "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": 7389.0, "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": 7462.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 12179.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14426.39 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7085.32 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14122.67 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8643.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.0, "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": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11786.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 7610.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.45, "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": 7857.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7857.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6338.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7857.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7389.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14426.39 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7610.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIR REPR OF ANEURYSM,FLSE ANEURYSM,EXCIS", "code_information": [ { "code": "35011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8559.0, "discounted_cash": 5933.0, "minimum": 1122.04, "maximum": 8559.0, "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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": 5017.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5017.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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": 8559.0, "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": 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 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8559.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5268.84 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8559.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8559.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5017.94 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5268.84 }, { "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": 8559.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5268.84 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 1122.04, "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": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1122.04 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5015.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5017.94 }, { "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": 8559.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 8559.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 8559.0, "discounted_cash": 5933.0, "minimum": 1122.04, "maximum": 8559.0, "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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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": 5017.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5017.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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": 8559.0, "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": 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 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8559.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5268.84 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 8559.0 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 8559.0 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5017.94 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5268.84 }, { "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": 8559.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5268.84 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 1122.04, "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": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1122.04 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5015.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5017.94 }, { "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": 8559.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 8559.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc face-mm b9+marg 1.1-2 cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8087.0, "discounted_cash": 755.0, "minimum": 142.19, "maximum": 6469.6, "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": 1055.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 717.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 1996.05 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1954.03 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.12, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 142.19, "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": 755.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.19 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 1996.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.77, "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": 16071.0, "minimum": 9792.85, "maximum": 51814.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 19286.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14969.2, "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": 15717.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 16872.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 17116.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 16791.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 14220.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18853.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 20089.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23257.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 22500.53, "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": 26036.33, "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": 14969.2, "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": 14969.2, "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": 15118.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 24911.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 51814.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 16710.56 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 50723.92 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17678.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 14969.2, "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": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 15717.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24107.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 15418.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 15717.66, "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": 16071.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16071.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15645.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 16071.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14969.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51814.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15418.28, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4806.11, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 3515.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 3691.23, "additional_payer_notes": "105% 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": "Exc foot/toe tum dep 1.5cm/>", "code_information": [ { "code": "28041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9298.0, "discounted_cash": 3097.0, "minimum": 459.52, "maximum": 7438.4, "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": 1620.0 }, { "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 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": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2817.98 }, { "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": 2817.98 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 459.52, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 459.52 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2682.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.79 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8453.0, "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": 10143.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.45, "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": 8335.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 7875.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 7988.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 7837.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7541.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8799.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 10566.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 10855.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 11834.33, "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": 13694.01, "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": 7938.45, "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": 7938.45, "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": 8017.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13102.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 10419.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 7851.63 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 10200.24 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9298.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.45, "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": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12679.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8176.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8335.37, "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": 8453.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8453.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5434.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8453.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7938.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10419.6 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8176.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7178.0, "minimum": 3968.2604, "maximum": 14930.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 8613.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "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": 7099.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 6369.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 6461.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 6338.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 6423.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7117.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 8972.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8779.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 10049.33, "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": 11628.51, "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": 6761.85, "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": 6761.85, "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": 6829.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 11126.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14930.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 6202.05 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14615.84 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7895.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10767.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 6964.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 7099.94, "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": 7178.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7178.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6044.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 7178.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6761.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6964.71, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 24845.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26087.91, "additional_payer_notes": "105% 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": "Exc h-f-nk-sp b9+marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8625.0, "discounted_cash": 1761.0, "minimum": 134.03, "maximum": 6900.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 1996.05 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1954.03 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.68 }, { "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": 1594.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 134.03, "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": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.03 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1517.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 1996.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider 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" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 1518.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "Endoven ther chem adhes 1st", "code_information": [ { "code": "36482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7889.0, "discounted_cash": 5933.0, "minimum": 191.99, "maximum": 7889.0, "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": 1620.0 }, { "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 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": 3415.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5637.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 7889.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3415.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7889.0, "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": 7889.0, "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": 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 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7889.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3586.39 }, { "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": "Humana", "plan_name": "Humana Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6527.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3415.61 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3586.39 }, { "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": 7889.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3586.39 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 191.99, "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": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.99 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3413.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3415.61 }, { "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": 7889.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5933.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6111.79, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 6275.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6589.31, "additional_payer_notes": "105% 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 PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18850.0, "minimum": 6780.2, "maximum": 30538.5228, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 22621.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17533.8, "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": 18410.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 20154.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 20445.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 20057.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 16657.11, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22520.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 23563.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27781.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 26391.32, "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": 30538.52, "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": 17533.8, "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": 17533.8, "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": 17709.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 29218.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 12331.38 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 18692.87 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 12071.77 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20736.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 17533.8, "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": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 18410.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28276.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 18059.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 18410.49, "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": 18850.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18850.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12937.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 18850.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12331.38 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18059.81, "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": 9855.0, "discounted_cash": 1761.0, "minimum": 156.11, "maximum": 7884.0, "payers_information": [ { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.68 }, { "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": 1594.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.11 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1517.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 1518.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4334.56 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 11790.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12379.78, "additional_payer_notes": "105% 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": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8965.0, "minimum": 5283.1378, "maximum": 14523.5754, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 10758.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.01, "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": 8831.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "methodology": "case rate", "standard_charge_dollar": 8479.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "methodology": "case rate", "standard_charge_dollar": 8602.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "methodology": "case rate", "standard_charge_dollar": 8439.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 7990.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9475.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "case rate", "standard_charge_dollar": 11206.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11688.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 12551.24, "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": 14523.58, "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": 8411.01, "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": 8411.01, "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": 8495.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "case rate", "standard_charge_dollar": 13896.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 14467.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN EPO PPO", "methodology": "case rate", "standard_charge_dollar": 8039.18 }, { "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Work Comp", "methodology": "case rate", "standard_charge_dollar": 14163.22 }, { "payer_name": "Humana", "plan_name": "Humana Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9861.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.01, "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": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 8831.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13447.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "case rate", "standard_charge_dollar": 8663.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "methodology": "case rate", "standard_charge_dollar": 8831.56, "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": 8965.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7068.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 8965.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14467.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8663.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10094.0, "discounted_cash": 1761.0, "minimum": 181.93, "maximum": 8075.2, "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": 1411.0 }, { "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 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": 1518.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.68 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4334.56 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.68 }, { "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": 1594.68 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 181.93, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.93 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1517.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.74 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "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": 7405.0, "discounted_cash": 1761.0, "minimum": 440.26, "maximum": 5924.0, "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": 1620.0 }, { "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 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": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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": 1720.24 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.26 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1637.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 22307.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23422.94, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 46559.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 48887.94, "additional_payer_notes": "105% 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": "Exc hand tum deep < 1.5 cm", "code_information": [ { "code": "26116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7792.0, "discounted_cash": 1761.0, "minimum": 488.0, "maximum": 6233.6, "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": 1411.0 }, { "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 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": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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": 1720.24 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550.77 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1637.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 31465.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33038.66, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 45930.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 48226.61, "additional_payer_notes": "105% 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": "Exc hand tum deep 1.5 cm/>", "code_information": [ { "code": "26113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8785.0, "discounted_cash": 1761.0, "minimum": 571.5, "maximum": 7028.0, "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": 1620.0 }, { "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 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": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.24 }, { "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": 1720.24 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 571.5, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 571.5 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1637.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.32 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [ { "code": "58800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10451.0, "discounted_cash": 3451.0, "minimum": 317.32, "maximum": 8360.8, "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": 1620.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4261.79 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 317.32, "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": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 317.32 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3555.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 10451.0, "discounted_cash": 3451.0, "minimum": 317.32, "maximum": 8360.8, "payers_information": [ { "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "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": 3064.55 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 317.32, "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": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 317.32 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2916.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 1620.0 }, { "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 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": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3064.55 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 4261.79 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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" } ] } ] }, { "description": "EXC HIPPELV TUM DEEP 5 CM>", "code_information": [ { "code": "27045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5756.5, "discounted_cash": 3097.0, "minimum": 800.62, "maximum": 5756.5, "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": 1620.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 800.62, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.62 }, { "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": 2247.22 }, { "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": 5756.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5756.5, "discounted_cash": 3097.0, "minimum": 800.62, "maximum": 5756.5, "payers_information": [ { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider 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": 1620.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 800.62, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.62 }, { "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": 2247.22 }, { "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": 5756.5, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drainage of hip joint", "code_information": [ { "code": "27030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 7737.0, "minimum": 987.44, "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": 9090.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1620.0 }, { "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 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": 5220.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill MyBlue Plus POS", "methodology": "fee schedule", "standard_charge_dollar": 9090.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9090.0, "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": 9090.0, "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": 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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9090.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5481.42 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5481.42 }, { "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": 9090.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5481.42 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 987.44, "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": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 987.44 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5217.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5220.4 }, { "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": "case rate", "standard_charge_dollar": 1433.3, "additional_payer_notes": "221.10% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1433.3, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DRAININJECT JOINTBURSA", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 327.0, "minimum": 35.04, "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": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 309.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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": 4264.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 649.03 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "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": 324.6 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.04 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 308.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4264.0, "discounted_cash": 327.0, "minimum": 35.04, "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": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 309.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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": 4264.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 649.03 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 324.6 }, { "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": 324.6 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.04 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 308.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 309.14 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc legankle tum dep 5 cm>", "code_information": [ { "code": "27634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4344.0, "discounted_cash": 3097.0, "minimum": 709.76, "maximum": 4344.0, "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": 1620.0 }, { "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 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": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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": 4344.0, "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": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4344.0 }, { "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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4344.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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": 4344.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 709.76, "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": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 709.76 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3926.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": 4344.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 4344.0, "discounted_cash": 3097.0, "minimum": 709.76, "maximum": 4344.0, "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": 1620.0 }, { "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 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": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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": 4344.0, "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": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4344.0 }, { "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 Systems", "plan_name": "Clifton Health System Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4344.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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": 4344.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4124.79 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 709.76, "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": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 709.76 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3926.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3928.37 }, { "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": 4344.0, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "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": 9090.0, "discounted_cash": 1761.0, "minimum": 334.68, "maximum": 7272.0, "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": 1411.0 }, { "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 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": 2907.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3053.0 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3053.0 }, { "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": 3053.0 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 334.68 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2905.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc arm/elbow les sc 3 cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9475.0, "discounted_cash": 3097.0, "minimum": 450.57, "maximum": 7580.0, "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": 1620.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 450.57 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 1684.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 1768.36, "additional_payer_notes": "105% 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": "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 2576.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2705.14, "additional_payer_notes": "105% 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": "Exc neck les sc 3 cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111.0, "discounted_cash": 3097.0, "minimum": 496.4, "maximum": 12088.8, "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": 1620.0 }, { "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 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": 2907.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3053.0 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.62 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3053.0 }, { "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": 3053.0 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 496.4, "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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 496.4 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2905.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.62 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "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": 10068.0, "discounted_cash": 3097.0, "minimum": 818.06, "maximum": 8054.4, "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": 1620.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.06 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare 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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 8310.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8725.66, "additional_payer_notes": "105% 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": "Dstrj nulyt agt gnclr nrv", "code_information": [ { "code": "64624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7083.0, "discounted_cash": 2082.0, "minimum": 143.58, "maximum": 5666.4, "payers_information": [ { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.58 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1605.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1606.85 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "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": 2498.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1055.0 }, { "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 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": 1606.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1606.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1687.19 }, { "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 Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2290.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1606.85 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1687.19 }, { "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": 1687.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11304.0, "discounted_cash": 3097.0, "minimum": 488.0, "maximum": 9043.2, "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": 1411.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 596.72, "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": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.72 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 11304.0, "discounted_cash": 3097.0, "minimum": 488.0, "maximum": 9043.2, "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": 1411.0 }, { "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 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": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5759.08 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2247.22 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2359.58 }, { "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": 2359.58 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 596.72, "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": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.72 }, { "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": 2247.22 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "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": 10816.0, "discounted_cash": 3451.0, "minimum": 322.12, "maximum": 8652.8, "payers_information": [ { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider 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": 1620.0 }, { "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 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": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3279.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 5886.07 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3451.96, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3212.08 }, { "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": 3212.08 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 322.12 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3057.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3059.12 }, { "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" } ] } ] }, { "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 Medicaid", "methodology": "case rate", "standard_charge_dollar": 7784.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8173.89, "additional_payer_notes": "105% 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": "DX BRONCHOSCOPEBRUSH", "code_information": [ { "code": "31623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4163.53, "discounted_cash": 1898.0, "minimum": 130.35, "maximum": 4163.53, "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": 1411.0 }, { "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 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": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% 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": 4163.53 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 2733.18 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2363.09 }, { "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": 2363.09 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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 Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2249.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2250.56 }, { "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": 4163.53, "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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 Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 0.6-1 cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7250.0, "discounted_cash": 433.0, "minimum": 101.97, "maximum": 5800.0, "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": 1055.0 }, { "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 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": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 411.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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": 365.0 }, { "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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Work Comp", "methodology": "case rate", "standard_charge_dollar": 1199.68 }, { "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 Work Comp", "methodology": "case rate", "standard_charge_dollar": 1174.42 }, { "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": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "Illini Care", "plan_name": "IlliniCare (Now Aetna Better Health) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.49, "additional_payer_notes": "100.00% 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": "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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.41 }, { "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": 554.41 }, { "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": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) 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": 101.97, "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": 433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.97 }, { "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 - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 527.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.01 }, { "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": "United Behavioral", "plan_name": "United Behavioral Health Medicare", "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": 1199.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc chest wall tumor w/ribs", "code_information": [ { "code": "21601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12101.0, "discounted_cash": 3097.0, "minimum": 1309.61, "maximum": 9680.8, "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": 2268.0 }, { "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 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": 2907.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Ill 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 Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2907.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% 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 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 Systems", "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": "County Care", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3053.0 }, { "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 Med